Lilah Michelle Blalock
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Atlanta, GA
NPI 1083418461 · NPPES record last updated Apr 3, 2025
Key facts
- NPI
- 1083418461
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 1364 Clifton Rd NE
Atlanta, GA 30322-1059 - Phone
- (404) 712-2000
- NPI assigned
- Apr 3, 2025
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250507001529 | GA | Order and Referring Only - Anesthesiology |
9638696222 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
1364 Clifton Rd NE
Atlanta, GA 30322-1059
Mailing address
11465 Holly Fern CT
San Diego, CA 92131-3739
Phone (858) 395-0213
Other providers in Atlanta, GA
- Kayla Blalock-Brazile
- Andrew Clark Blalock
- Dedra J Blalock
- Erin Blalock
- Jessica M Blalock
- Tishuna Blanch
- Damian Blanchard-McIntosh
- Clifford Blanchard IV
- David Blanchard
- Isabelle Blanchard
All providers in Atlanta, GA · Student in an Organized Health Care Education/Training Program in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.