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General NPI Number Information
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NPI Number | 1730315870
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST HEALTHCARE P.C.
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 939 THORNTON RD
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-2634
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Country | US
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Telephone | 770-739-1233
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Fax | 770-948-4930
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Provider Business Mailing Address
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Address Line | 939 THORNTON RD
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-2634
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Country | US
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Telephone | 770-739-1233
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Fax | 770-948-4930
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRYAN D BLAKE
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Credential | M.D.
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Telephone | 770-739-1233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 040613
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License Number State | GA
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