Individual
SHEILA D BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MNS,CPNP
Contact information
Practice address
1045 SOUTHCREST DR, SUITE 110, STOCKBRIDGE, GA 30281-6113
(770) 507-2212
(770) 507-2213
Mailing address
1045 SOUTHCREST DR, SUITE 110, STOCKBRIDGE, GA 30281-6113
(770) 507-2212
(770) 507-2213
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
21932
GA
Other
Enumeration date
03/16/2007
Last updated
01/30/2013
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