Individual
OPAL MULLINGS BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
631 PROFESSIONAL DR STE 350, LAWRENCEVILLE, GA 30046-3370
(770) 995-0630
(770) 995-1555
Mailing address
631 PROFESSIONAL DR, SUITE 350, LAWRENCEVILLE, GA 30046
(770) 995-0630
(770) 682-0088
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN 199200
GA
363L00000X
Nurse Practitioner
RN199200
GA
Other
Enumeration date
08/04/2014
Last updated
01/04/2016
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