Healthcare Provider Details

I. General information

NPI: 1609961598
Provider Name (Legal Business Name): DONALD LEON BLOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993C JOHNSON-FERRY RD ST 120
ATLANTA GA
30342
US

IV. Provider business mailing address

993C JOHNSON-FERRY RD ST 120
ATLANTA GA
30342
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-6099
  • Fax: 404-255-8083
Mailing address:
  • Phone: 404-255-6099
  • Fax: 404-255-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number010782
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207VC0200X
TaxonomyCritical Care Medicine (Obstetrics & Gynecology) Physician
License Number010782
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: