Individual
DR. BRYAN DAVID BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
939 THORNTON RD, LITHIA SPRINGS, GA 30122-2634
(770) 948-5400
(770) 948-4930
Mailing address
939 THORNTON RD, LITHIA SPRINGS, GA 30122-2634
(770) 948-5400
(770) 948-4930
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
040613
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00687409D
—
GA
Enumeration date
08/26/2005
Last updated
06/30/2020
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