MEDICARE: DR. ANDREW CLARK BLALOCK PH.D.

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	103T00000X	Psychologist	0002482	GA

General Provider Information

NPI Number	:	1659415412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW CLARK BLALOCK PH.D.

Provider Business Mailing Address
First Line	:	406 LONG BRANCH WAY
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-4594
Country	:	US
Telephone Number	:	404-202-6501
Fax Number	:	404-651-4664

Provider Business Practice Location Address
First Line	:	4167 ROSWELL RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-3715
Country	:	US
Telephone Number	:	404-202-6501
Fax Number	:

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	01/07/2009

Similar Medicare Providers

1518185313 — DR. WILLIAM W SUN D.C.
Practice Location Address:

4161 ROSWELL RD NE
ATLANTA, GA
30342-3715

Practice Phone: 404-252-4566
Practice Fax: 404-252-4689

1891031472 — DR. ROBERT MANIS MD
Practice Location Address:

4167 ROSWELL RD
ATLANTA, GA
30342-3715

Practice Phone: 404-252-5055
Practice Fax: 404-252-5589

1871585158 — MRS. NANCY C MCINNIS PA
Practice Location Address:

3715 NORTHSIDE PKWY NW STE 2-100
ATLANTA, GA
30327-2809

Practice Phone: 404-663-6130
Practice Fax: 404-289-5362

1952357873 — MOBILITY DESIGNS
Practice Location Address:

3715 NORTHCREST RD , SUITE 28
ATLANTA, GA
30340-3411

Practice Phone: 770-458-1329
Practice Fax: 770-457-3229

1891879813 — A.G. RHODES EXTENDACARE, INC.
Practice Location Address:

3715 NORTHSIDE PKWY NW , BUILDING 400, SUITE 305
ATLANTA, GA
30327-2806

Practice Phone: 404-949-3830
Practice Fax: 404-949-3831

1457415846 — JOHN G. KEATING MD, PC
Practice Location Address:

3715 NORTHSIDE PKWY , BUILDING 400, SUITE 150
ATLANTA, GA
30327

Practice Phone: 404-233-5252
Practice Fax: 404-233-0490

Directions to “ DR. ANDREW CLARK BLALOCK PH.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.