Phyllisa Dawn Blake, RN

Key facts

NPI

1629329453

Entity type

Individual (NPI type 1)

Primary specialty

Registered Nurse 163W00000X

License

RN196553 (GA)

Practice address

3807 Clairmont Rd
Chamblee, GA 30341-4911

Phone

(770) 454-1144

Fax

(770) 452-4468

NPI assigned

Sep 19, 2012

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Registered Nurse

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 24, 2012.

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348444800000",
    "number": "1629329453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4312 RICKENBACKER WAY NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303423713",
            "telephone_number": "404-914-7136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3807 CLAIRMONT RD",
            "city": "CHAMBLEE",
            "state": "GA",
            "postal_code": "303414911",
            "telephone_number": "770-454-1144",
            "fax_number": "770-452-4468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "PHYLLISA",
        "middle_name": "DAWN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-19",
        "last_updated": "2012-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN196553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chamblee, GA

• Victor Berkovich, DMD
• Brent Bertschinger, DC
• David O. Bidot, M.D.
• Shawn Gene Bisacco, D.C.
• Sarah Blackwell, M.ED., CCC-SLP
• Dillon Blankenship, DC
• Shannon M Blankenship, BS,IBCLC,RLC
• Andrea K Boc, LCSW
• Keilani Body
• Adrian Box, M.D.

All providers in Chamblee, GA · Registered Nurse in Georgia