Individual
MR. BLAKE EDWARD SIDLECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
550 PEACHTREE ST NE STE 1700, ATLANTA, GA 30308-2262
(484) 951-3217
Mailing address
5479 GLENRIDGE DR APT 4404, ATLANTA, GA 30342-1340
(484) 951-3217
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/30/2025
Last updated
06/30/2025
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