MEDICARE: DR. BRYAN DAVID BLAKE MD

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	207Q00000X	Family Medicine Physician	040613	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316930118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN DAVID BLAKE MD

Provider Business Mailing Address
First Line	:	939 THORNTON RD
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-2634
Country	:	US
Telephone Number	:	770-948-5400
Fax Number	:	770-948-4930

Provider Business Practice Location Address
First Line	:	939 THORNTON RD
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-2634
Country	:	US
Telephone Number	:	770-948-5400
Fax Number	:	770-948-4930

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	06/30/2020

Similar Medicare Providers

1306860044 — MR. MILLARD JAMES COLLIER M.D.
Practice Location Address:

939 THORNTON RD
LITHIA SPRINGS, GA
30122-2634

Practice Phone: 770-948-5400
Practice Fax: 770-948-4930

1306905765 — PHYSIOTHERAPY ASSOCIATES
Practice Location Address:

939 THORNTON RD
LITHIA SPRINGS, GA
30122-2634

Practice Phone: 770-739-3880
Practice Fax: 770-739-3881

1306906532 — ONDRELL MOORE
Practice Location Address:

939 THORNTON RD
LITHIA SPRINGS, GA
30122-2634

Practice Phone: 770-739-3880
Practice Fax:

1437362225 — WEST ATLANTA PEDIATRICS, P.C.
Practice Location Address:

915 THORNTON RD
LITHIA SPRINGS, GA
30122-2634

Practice Phone: 770-739-9292
Practice Fax: 770-948-9126

1730315870 — FAMILY FIRST HEALTHCARE P.C.
Practice Location Address:

939 THORNTON RD
LITHIA SPRINGS, GA
30122-2634

Practice Phone: 770-739-1233
Practice Fax: 770-948-4930

1437386315 — LINDSEY MANGHAM RANSOM M.D.
Practice Location Address:

915 THORNTON RD
LITHIA SPRINGS, GA
30122-2634

Practice Phone: 770-739-9292
Practice Fax:

Directions to “ DR. BRYAN DAVID BLAKE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.