Blue Lake Health, LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

BLUE LAKE HEALTH, LLC

Practice address

1200 Memorial Dr
Dalton, GA 30720-2529

Phone

(706) 272-6000

NPI assigned

Jan 13, 2021

Organization subpart

No

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

Authorized official

Name

Robert E Patrick Jr.

Title

Ceo

Phone

(205) 977-1949

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1265021364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT #8318",
            "address_2": "PO BOX 11407",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "35246",
            "telephone_number": "205-977-1949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 MEMORIAL DR",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202529",
            "telephone_number": "706-272-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1250 Broadrick Dr",
            "address_purpose": "LOCATION",
            "city": "Dalton",
            "state": "GA",
            "postal_code": "307202503",
            "country_code": "US",
            "telephone_number": "706-876-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLUE LAKE HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-13",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "PATRICK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "205-977-1949",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abdullah Salah Abdullah Binsaeedu, M.B.B.S.
• Bio-Medical Applications of Georgia, Inc.
• Biotech Labs LLC
• William M Blackman Jr., M.D.
• James C Blackwell, M.D.
• Brandon Woodrow Boggess, LMSW
• Vincent Blake Boling, CRNA
• Ryan Bonanno, ATC
• Carmen Rose Bond, LMT, CNMT
• Holly Nicole Bottoms, A-GNP-C

• Anesthesiology Physician in Dalton, GA
• Providers in Dalton, GA by specialty
• Anesthesiology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.