Individual
MS. NIKKIA BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
677 CHURCH ST NE, MARIETTA, GA 30060-1101
(770) 793-7763
Mailing address
677 CHURCH ST NE, MARIETTA, GA 30060-1101
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
89739
GA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
89739
GA
Other
Enumeration date
03/28/2018
Last updated
08/18/2024
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