Israel Dennard Blake

Primary specialty

Religious Nonmedical PractitionerTaxonomy code 374K00000X

Practice address

228 Augusta Ave
Thomasville, GA 31792-7003

Phone

(229) 228-7775

NPI assigned

Jun 28, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• The Disciples of Jesus House of Prayer & Deliverance

  • Religious Nonmedical Health Care Institution
  • Thomasville, GA
  • NPI 1972350460

  Pastoral

  NPD

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

{
    "created_epoch": "1719532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1598500605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2763",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317992763",
            "telephone_number": "229-228-7775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 AUGUSTA AVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317927003",
            "telephone_number": "229-228-7775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "ISRAEL",
        "middle_name": "DENNARD",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-28",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "374K00000X",
            "taxonomy_group": "",
            "desc": "Religious Nonmedical Practitioner",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Dawn Bishop, PTA
• Black Sheep Trauma and Recovery LLC
• Christopher Blagg, PH.D.
• Richard Edward Blais Jr., PT
• Chandra Blake, BS, MS
• Salvatore M. Blandino, C.P.
• Julia Blanton, CHES, DIPACLM, CHWC
• Tracey Coston Blocker, OTR/L
• Blooming Minds Psychiatry, LLC
• Winston William Leland Bogan

• Religious Nonmedical Practitioner in Thomasville, GA
• Providers in Thomasville, GA by specialty
• Religious Nonmedical Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; 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.