Individual
DR. ANDREW CLARK BLALOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4167 ROSWELL RD NE, ATLANTA, GA 30342-3715
(404) 202-6501
Mailing address
406 LONG BRANCH WAY, CANTON, GA 30115-4594
(404) 202-6501
(404) 651-4664
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0002482
GA
Other
Enumeration date
02/16/2007
Last updated
01/07/2009
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