Amanda Puckett Blake, CNM

Primary specialty

MidwifeTaxonomy code 176B00000X

License

RN173764 Issued in GA

Practice address

1791 Mulkey Rd Ste 200
Austell, GA 30106-1124

Phone

(770) 732-5400

NPI assigned

Aug 21, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Amanda Loraine Puckett Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1144053596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 SHOALS TRL",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301326045",
            "telephone_number": "404-275-0054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1791 MULKEY RD STE 200",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061124",
            "telephone_number": "770-732-5400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Greystone Power Blvd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "GA",
            "postal_code": "301578297",
            "country_code": "US",
            "telephone_number": "678-945-8345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "AMANDA",
        "middle_name": "PUCKETT",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-21",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "GA",
            "license": "RN173764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "PUCKETT",
            "middle_name": "LORAINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bio-Medical Applications of Georgia, Inc.
• Catherine Tinker Bittinger, PA-C
• BJS Wholesale Club Inc
• Shanekkia Black, MD
• Elizabeth P Blackwood, NP
• Jacob Nathan Blatt, M.D.
• Sophia Antonia Blue, LPTA
• Robert M Blum, O.D.
• Jennifer Boatwright, MD
• Bodyset Inc

• Midwife in Austell, GA
• Providers in Austell, GA by specialty
• Midwife in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.