Individual
GABRIELLE N. BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
156 FOSTER DR STE B, MCDONOUGH, GA 30253-5346
(770) 506-4119
Mailing address
675 LAFAYETTE AVE APT 3207, FAYETTEVILLE, GA 30214-5553
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
12282
GA
363A00000X
Physician Assistant
—
—
Other
Enumeration date
01/06/2015
Last updated
05/16/2025
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