Individual
BLAKE THOR BENDIXEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
303 PARKWAY DR NE, ATLANTA, GA 30312-1239
(404) 265-4000
Mailing address
303 PARKWAY DR NE, ATLANTA, GA 30312-1239
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/31/2020
Last updated
04/08/2020
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