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General NPI Number Information
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NPI Number | 1477587822
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Entity Type | Individual
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Provider Name | MARLENE LOUISE BLAISE MD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 3400-C OLD MILTON PKWY SUITE 325
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City | ALPHARETTA
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State | GA
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Zip | 30005-4433
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Country | US
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Telephone | 678-762-0910
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Fax | 678-762-0920
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Provider Business Mailing Address
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Address Line | 3400-C OLD MILTON PKWY SUITE 325
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City | ALPHARETTA
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State | GA
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Zip | 30005-4433
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Country | US
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Telephone | 678-762-0910
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Fax | 678-762-0920
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 48028
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License Number State | GA
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