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General NPI Number Information
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NPI Number | 1083346001
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Entity Type | Individual
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Provider Name | DEONTA LASHEA BLOUNT LPN
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Gender | Female
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 798 RAYS RD STE 100
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-3144
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Country | US
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Telephone | 470-736-9644
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Fax | 404-549-3151
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Provider Business Mailing Address
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Address Line | 798 RAYS RD STE 100
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-3144
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Country | US
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Telephone | 470-736-9644
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Fax | 404-549-3151
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | LPN072168
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License Number State | GA
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