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NPI Code Detail

MEDICARE: MISS KAYLA BLALOCK-BRAZILE

MEDICARE: MISS KAYLA BLALOCK-BRAZILE
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1467969642
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KAYLA BLALOCK-BRAZILE
Provider Business Mailing Address
First Line : 1611 HARBOR WALK STE 1611
Second Line :
City : FAIRBURN
State : GA
Zip : 30213-3945
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2805 METROPOLITAN PKWY SW
Second Line :
City : ATLANTA
State : GA
Zip : 30315-7915
Country : US
Telephone Number : 404-612-4111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2018
Last Update Date : 04/07/2026

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Directions to “ MISS KAYLA BLALOCK-BRAZILE ” Practice Location

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