Individual
PHYLLISA DAWN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3807 CLAIRMONT RD, CHAMBLEE, GA 30341-4911
(770) 454-1144
(770) 452-4468
Mailing address
4312 RICKENBACKER WAY NE, ATLANTA, GA 30342-3713
(404) 914-7136
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN196553
GA
Other
Enumeration date
09/19/2012
Last updated
09/24/2012
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