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General NPI Number Information
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NPI Number | 1376220335
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Entity Type | Individual
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Provider Name | PEYTON PATRICIA BLAYLOCK
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Gender | Female
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Dates
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Enumeration Date | 06/30/2023
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 2701 N DECATUR RD
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City | DECATUR
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State | GA
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Zip | 30033-5918
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Country | US
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Telephone | 404-501-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 731 FERN ST SE
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City | MARIETTA
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State | GA
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Zip | 30067-6731
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Country | US
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Telephone | 205-567-1913
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 12544
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License Number State | GA
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