Individual
DR. NYDIA M BLADUELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
55 WHITCHER ST NE, SUITE 350, MARIETTA, GA 30060-1155
(770) 424-6893
(770) 528-9938
Mailing address
55 WHITCHER ST NE, SUITE 350, MARIETTA, GA 30060-1155
(770) 424-6893
(770) 528-9938
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
038429
GA
207RI0011X
Interventional Cardiology Physician
Primary
038429
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000599057D
—
GA
05
—
000599057E
—
GA
05
—
000599057F
—
GA
05
—
000599057G
—
GA
05
—
000599057H
—
GA
05
—
000599057I
—
GA
05
—
000599057M
—
GA
Enumeration date
08/09/2005
Last updated
10/10/2019
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