Organization
VICTOR J BLAKE & ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARLA BENNETT (OFFICE MANAGER)
(770) 996-7622
Entity
Organization
Contact information
Practice address
1897 GODBY RD, COLLEGE PARK, GA 30349-5235
(770) 996-7622
(770) 996-5469
Mailing address
1897 GODBY RD, COLLEGE PARK, GA 30349-5235
(770) 996-7622
(770) 996-5469
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0510780
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000685935H
—
GA
Enumeration date
07/03/2008
Last updated
07/03/2008
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