Individual
ROBERT DOUGLAS BLIESATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5 EXECUTIVE CIR, SAVANNAH, GA 31406-3345
(912) 355-2400
(912) 355-5324
Mailing address
5 EXECUTIVE CIR, SAVANNAH, GA 31406-3345
(912) 355-2400
(912) 355-5324
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003117
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001614A
—
GA
05
—
100001614B
—
GA
01
—
10059029
AMERIGROUP
GA
Enumeration date
06/26/2006
Last updated
05/23/2008
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