MEDICARE: GEORGIA L BLAIR MD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1033752431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA L BLAIR MD, PLLC

Provider Business Mailing Address
First Line	:	1600 W COLLEGE ST STE 540
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-3589
Country	:	US
Telephone Number	:	817-481-5863
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 W COLLEGE ST STE 540
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-3589
Country	:	US
Telephone Number	:	817-481-5863
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS SUPERVISOR
Name	:	CAROLE BURNS
Credential	:
Telephone Number	:	817-481-5863

Provider Enumeration Date	:	10/18/2019
Last Update Date	:	10/18/2019

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