Individual
JUSTIN BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1814 WESTCHESTER DR, STE 201, HIGH POINT, NC 27262-7369
(336) 802-2090
(336) 802-2091
Mailing address
1701 WESTCHESTER DR, STE 850, HIGH POINT, NC 27262-7254
(336) 802-2400
(336) 802-2534
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
955
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
955
PA LICENSE
SC
Enumeration date
05/24/2006
Last updated
12/30/2009
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