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General NPI Number Information
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NPI Number | 1780659128
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Entity Type | Individual
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Provider Name | JOHN THOMAS BLASINGAME III M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2045 PEACHTREE RD NE SUITE 300
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City | ATLANTA
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State | GA
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Zip | 30309-1414
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Country | US
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Telephone | 404-352-4440
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Fax | 404-352-4446
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Provider Business Mailing Address
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Address Line | 2759 ENGLE RD NW
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City | ATLANTA
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State | GA
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Zip | 30318-7214
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Country | US
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Telephone | 404-794-0399
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Fax | 404-794-3380
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 035379
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License Number State | GA
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