Individual
DWIGHT D BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4910 JONESBORO RD, BLDG. 700, STE. 1, UNION CITY, GA 30291-2085
(770) 964-7736
(770) 306-1726
Mailing address
4910 JONESBORO RD, BLDG. 700, STE. 1, UNION CITY, GA 30291-2085
(770) 964-7736
(770) 306-1726
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
51117
GA
Other
Enumeration date
06/09/2006
Last updated
05/13/2010
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