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General NPI Number Information
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NPI Number | 1457594442
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Entity Type | Organization
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Legal Business Name | JASON D. BLANKENSHIP & ASSOCIATES, P.C.
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 2277 PEACHTREE RD NE SUITE C
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City | ATLANTA
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State | GA
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Zip | 30309-1168
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Country | US
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Telephone | 404-367-0682
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Fax | 404-367-9297
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Provider Business Mailing Address
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Address Line | 2277 PEACHTREE RD NE SUITE C
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City | ATLANTA
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State | GA
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Zip | 30309-1168
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Country | US
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Telephone | 404-367-0682
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Fax | 404-367-9297
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON DOUGLAS BLANKENSHIP
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Credential | O.D.
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Telephone | 404-367-0682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | OPT002308
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License Number State | GA
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