Healthcare Provider Details

I. General information

NPI: 1316022627
Provider Name (Legal Business Name): DAVID M. BLOMERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1292 ATHENS ST
GAINESVILLE GA
30507-7000
US

IV. Provider business mailing address

601 S. ENOTA DRIVE STE. Q
GAINESVILLE GA
30501
US

V. Phone/Fax

Practice location:
  • Phone: 770-531-5654
  • Fax: 770-532-5341
Mailing address:
  • Phone: 770-533-8406
  • Fax: 770-533-8409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number040870
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: