Individual
GARRETT BLOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
500 MARTHA JEFFERSON DR, CHARLOTTESVILLE, VA 22911-4668
(336) 512-5308
Mailing address
702 MILL POINTE WAY, ELON, NC 27244-9380
(336) 512-5308
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110010015
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
03/19/2024
Last updated
09/30/2024
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