Mary Blalock
Nurse Practitioner - Family Medicine
107 Lake Reserve Way
Holly Springs
, Georgia 30115-4785
Mary Blalock
Nurse Practitioner - Family Medicine
107 Lake Reserve Way
Holly Springs
, Georgia 30115-4785
(770) 354-0471
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About
Features
Specialties
- Nurse Practitioner - Family Medicine
Languages spoken
- English
Location
First Address
- Mary Blalock
- 107 Lake Reserve Way
- Holly Springs, GA
- Zip : 30115-4785
- Phone : (770) 354-0471
Second Address
- Mary Blalock
- 107 Lake Reserve Way
- Holly Springs, GA
- Zip : 30115-4785
- Phone : (770) 354-0471
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN129711 | GA |
National Provider Identifier
| NPI | 1003349671 |
|---|---|
| Provider Name | Mary Blalock |
| First Address | Holly Springs, GA 30115-4785 |
| Second Address | Holly Springs, GA 30115-4785 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 10/04/2017 |
| Last Update Date | 10/04/2017 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.