Individual
MR. WALTER R BLASE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.S., A.T.C
Contact information
Practice address
101 MARIETTA ST NW, SUITE 1900, ATLANTA, GA 30303-2720
(404) 878-3513
Mailing address
605 BASSETT CT SE, SMYRNA, GA 30080-5528
(678) 842-0212
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
AT000742
GA
Other
Enumeration date
02/08/2006
Last updated
07/08/2007
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