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General NPI Number Information
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NPI Number | 1467951707
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Entity Type | Individual
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Provider Name | CHRISTOPHER BLAKE COUEY PA
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Gender | Male
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 1412 MILSTEAD AVE NE STE 100
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City | CONYERS
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State | GA
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Zip | 30012-3877
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Country | US
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Telephone | 770-483-9330
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Fax |
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Provider Business Mailing Address
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Address Line | 120 W WASHINGTON ST
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-3434
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Country | US
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Telephone | 478-414-8184
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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 | 8623
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License Number State | GA
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