MEDICARE: TASIA BLAIR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1063122349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASIA BLAIR

Provider Business Mailing Address
First Line	:	2960 FLOWERS RD S # LOFT1306
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-5512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2960 FLOWERS RD S # LOFT1306
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-5512
Country	:	US
Telephone Number	:	412-452-0237
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	11/28/2022

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Directions to “ TASIA BLAIR ” Practice Location

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