Individual
MR. BRIAN DEWAYNE BLANTON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3294 NORTH OAK ST. EXT., VALDOSTA, GA 31602
(229) 241-1188
(229) 245-7106
Mailing address
3294 NORTH OAK ST. EXT., VALDOSTA, GA 31605
(229) 241-1188
(229) 245-7106
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5290
GA
Other
Enumeration date
04/09/2008
Last updated
03/07/2012
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