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NPI Code Detail

MEDICARE: BLACKSTONE HEALTH SERVICES LLC

MEDICARE: BLACKSTONE HEALTH SERVICES LLC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1295680437
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLACKSTONE HEALTH SERVICES LLC
Provider Business Mailing Address
First Line : 2470 WINDY HILL RD SE STE 300
Second Line :
City : MARIETTA
State : GA
Zip : 30067-8621
Country : US
Telephone Number : 678-904-2450
Fax Number : 678-904-2320
Provider Business Practice Location Address
First Line : 2470 WINDY HILL RD SE STE 300
Second Line :
City : MARIETTA
State : GA
Zip : 30067-8621
Country : US
Telephone Number : 678-904-2450
Fax Number : 678-904-2320
Authorized Official
Title or Position : CEO
Name : ELIJIAH DAVIS
Credential :
Telephone Number : 678-904-2450
Provider Enumeration Date : 03/03/2026
Last Update Date : 03/03/2026

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Directions to “BLACKSTONE HEALTH SERVICES LLC ” Practice Location

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