Individual
AMANDA PUCKETT BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
1791 MULKEY RD STE 200, AUSTELL, GA 30106-1124
(770) 732-5400
Mailing address
42 SHOALS TRL, DALLAS, GA 30132-6045
(404) 275-0054
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
RN173764
GA
Other
Enumeration date
08/21/2024
Last updated
08/21/2024
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