Individual
LISA DOVE BLAKELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1659 WOODBRIDGE LN NE, ATLANTA, GA 30329-3536
(678) 548-1416
Mailing address
1659 WOODBRIDGE LN NE, ATLANTA, GA 30329-3536
(678) 548-1416
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
RN127654
GA
Other
Enumeration date
06/05/2017
Last updated
03/17/2018
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