Individual
MS. MIRANDA FORDHAM BLAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP-BC
Contact information
Practice address
3369 BUFORD HWY NE STE 810A, BROOKHAVEN, GA 30329-1742
(404) 321-4692
Mailing address
491 PARK VALLEY DR NW, ATLANTA, GA 30318-6251
(706) 248-6020
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
RN216488
GA
363LW0102X
Women's Health Nurse Practitioner
Primary
RN216488
GA
Other
Enumeration date
06/02/2017
Last updated
02/18/2022
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