Brian Dewayne Blanton Jr., PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5290 Issued in GA

Practice address

3294 North Oak St. Ext.
Valdosta, GA 31602

Phone

(229) 241-1188

Fax

(229) 245-7106

NPI assigned

Apr 9, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331078400000",
    "number": "1265605372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3294 NORTH OAK ST. EXT.",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31605",
            "telephone_number": "229-241-1188",
            "fax_number": "229-245-7106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3294 NORTH OAK ST. EXT.",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31602",
            "telephone_number": "229-241-1188",
            "fax_number": "229-245-7106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANTON",
        "first_name": "BRIAN",
        "middle_name": "DEWAYNE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-09",
        "last_updated": "2012-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "5290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Blair
• Tanasha Blair, M. ED
• Blakely Harper LCSW PC
• Dustin Bradley Blalock
• Heather F Blanchard, MED. CCC-SLP
• Blissett Health Service
• Daniel Lock Boatright, CRNA
• Samuel Thomas Bobo, PHARM.D.
• Justin Mark Booth, AA
• Mildred Itaska Borowski, LPC

• Physician Assistant in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2012; 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.