Healthcare Provider Details

I. General information

NPI: 1093639320
Provider Name (Legal Business Name): PORSHA BLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PORSHA ELAM-BLAIR

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3050
US

IV. Provider business mailing address

1506 EASTWOOD VILLAGE DR
STOCKBRIDGE GA
30281-7743
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN285831
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: