Active NPI
Dennis James Blue Jr., P.A.
- Medical Physician Assistant
- Fort Stewart, GA
National Provider Identifier
1669510541
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 0110001630
- Practice address
- 1061 Harmon Ave
Suite 1D03
Fort Stewart, GA 31314-5641 - Phone
- (912) 401-4423
- NPI assigned
- Feb 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 0110001630 | VA | Primary |
Addresses
Primary practice location
1061 Harmon Ave
Suite 1D03
Fort Stewart, GA 31314-5641
Mailing address
1061 Harmon Ave
Suite 1D03
Fort Stewart, GA 31314-5641
Phone (912) 401-4423
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110001630 | VA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299110400000",
"number": "1669510541",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1061 HARMON AVE",
"address_2": "SUITE 1D03",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "313145641",
"telephone_number": "912-401-4423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1061 HARMON AVE",
"address_2": "SUITE 1D03",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "313145641",
"telephone_number": "912-401-4423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLUE",
"first_name": "DENNIS",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2011-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "VA",
"license": "0110001630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Stewart, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.