Individual
SHIRLEY BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RNC
Contact information
Practice address
3509 MABRY ROAD, GAINESVILLE, GA 30504-7979
(770) 536-2310
Mailing address
4331 THURMOND TANNER PARKWAY, FLOWERY BRANCH, GA 30542-7979
(678) 513-5700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN125274
GA
Other
Enumeration date
04/01/2009
Last updated
04/01/2009
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