Individual
BLAKE ANTHONY LANDRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
148 BILL CARRUTH PKWY STE 100, HIRAM, GA 30141-3756
(770) 422-1372
(678) 363-5170
Mailing address
148 BILL CARRUTH PKWY STE 100, HIRAM, GA 30141-3756
(770) 422-1372
(678) 363-5170
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TA1743
AL
Other
Enumeration date
08/16/2012
Last updated
10/30/2019
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