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NPI Code Detail

MEDICARE: AKILAH S. BLAYLOCK PT

MEDICARE: AKILAH S. BLAYLOCK PT
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
1225100000XPhysical Therapist23789MD
2225100000XPhysical TherapistPT009057GA

General Provider Information

NPI Number : 1326244856
Entity Type Code : Individual
Provider Name (Legal Business Name) : AKILAH S. BLAYLOCK PT
Provider Business Mailing Address
First Line : 7248 PARKLAND BND
Second Line :
City : FAIRBURN
State : GA
Zip : 30213-5435
Country : US
Telephone Number : 404-759-9288
Fax Number :
Provider Business Practice Location Address
First Line : 1800 HOWELL MILL RD NW STE 200
Second Line :
City : ATLANTA
State : GA
Zip : 30318-0917
Country : US
Telephone Number : 404-352-1015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2007
Last Update Date : 04/26/2018

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