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General NPI Number Information
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NPI Number | 1891720108
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Entity Type | Individual
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Provider Name | MICHAEL S. BLAISS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 1090 WINDFAIRE PL
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City | ROSWELL
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State | GA
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Zip | 30076-3307
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Country | US
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Telephone | 901-674-6075
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Fax |
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Provider Business Mailing Address
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Address Line | 1090 WINDFAIRE PL
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City | ROSWELL
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State | GA
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Zip | 30076-3307
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Country | US
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Telephone | 901-674-6075
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | MD00010264
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License Number State | TN
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