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General NPI Number Information
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NPI Number | 1619344223
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Entity Type | Individual
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Provider Name | ELIZABETH BLAIR PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 3025 SHRINE RD STE 290
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City | BRUNSWICK
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State | GA
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Zip | 31520-4785
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Country | US
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Telephone | 912-466-7660
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Fax | 912-264-1526
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Provider Business Mailing Address
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Address Line | 3025 SHRINE RD STE 290
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City | BRUNSWICK
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State | GA
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Zip | 31520-4785
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Country | US
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Telephone | 912-466-7660
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Fax | 912-264-1526
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 3744
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License Number State | GA
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