Individual
MR. ISRAEL DENNARD BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
228 AUGUSTA AVE, THOMASVILLE, GA 31792-7003
(229) 228-7775
Mailing address
PO BOX 2763, THOMASVILLE, GA 31799-2763
(229) 228-7775
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
—
GA
374K00000X
Religious Nonmedical Practitioner
Primary
—
GA
Other
Enumeration date
06/28/2024
Last updated
06/28/2024
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