Individual
MARY BLAESING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1688 LAWRENCEVILLE HWY, LAWRENCEVILLE, GA 30044-4608
(770) 995-2379
(770) 995-2385
Mailing address
1688 LAWRENCEVILLE HWY, LAWRENCEVILLE, GA 30044-4608
(770) 995-2379
(770) 995-2385
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT002459
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10037741
—
GA
05
—
306071
—
GA
Enumeration date
11/30/2006
Last updated
07/09/2007
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