Individual
BLAKK DIAMOND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
405 PHILIP BLVD APT 1305, LAWRENCEVILLE, GA 30046-8749
(706) 403-7257
Mailing address
405 PHILIP BLVD APT 1305, LAWRENCEVILLE, GA 30046-8749
(706) 403-7257
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
MT011268
GA
Other
Enumeration date
09/14/2020
Last updated
09/14/2020
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