Individual
MR. BLAISE MARCUS WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-A
Contact information
Practice address
677 CHURCH ST NE, MARIETTA, GA 30060-1101
(770) 794-0477
Mailing address
4047 THESSA CV NE, ROSWELL, GA 30075-5750
(678) 698-2111
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
—
—
Other
Enumeration date
07/11/2016
Last updated
08/26/2019
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