Organization
VICTOR J BLAKE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR J BLAKE MD (PRESIDENT)
(770) 996-7622
Entity
Organization
Contact information
Practice address
1897 GODBY RD, COLLEGE PARK, GA 30349-5235
(770) 996-7622
Mailing address
1897 GODBY RD, COLLEGE PARK, GA 30349-5235
(770) 996-7622
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
41081
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00685935H
—
GA
Enumeration date
01/31/2008
Last updated
01/31/2008
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