Healthcare Provider Details

I. General information

NPI: 1699229617
Provider Name (Legal Business Name): BLAKE AUSTIN HAMPTON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 ROCKBRIDGE RD STE 15A
STONE MOUNTAIN GA
30087-3301
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 470-977-2100
  • Fax: 470-977-2101
Mailing address:
  • Phone: 586-350-2644
  • Fax: 586-541-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012527
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: