Victor J Blake & Associates

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0510780 Issued in GA

Legal business name

VICTOR J BLAKE & ASSOCIATES

Practice address

1897 Godby Rd
College Park, GA 30349-5235

Phone

(770) 996-7622

Fax

(770) 996-5469

NPI assigned

Jul 3, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Marla Bennett

Title

Office Manager

Phone

(770) 996-7622

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215043200000",
    "number": "1588827166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1897 GODBY RD",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303495235",
            "telephone_number": "770-996-7622",
            "fax_number": "770-996-5469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1897 GODBY RD",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303495235",
            "telephone_number": "770-996-7622",
            "fax_number": "770-996-5469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTOR J BLAKE & ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-03",
        "last_updated": "2008-07-03",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "MARLA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-996-7622",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "0510780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000685935H",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in College Park, GA
• Providers in College Park, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; 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.