1831255520 NPI number — DENEESE BLANTON MD, RDN

Table of content: DENEESE BLANTON MD, RDN (NPI 1831255520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831255520 NPI number — DENEESE BLANTON MD, RDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANTON
Provider First Name:
DENEESE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, RDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLANTON
Provider Other First Name:
LAURIE
Provider Other Middle Name:
DENEESE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831255520
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 JESSE HILL JR DR SE
Provider Second Line Business Mailing Address:
WOMEN'S HEALTH CENTER
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30303-3050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-616-1000
Provider Business Mailing Address Fax Number:
404-616-8065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 JESSE HILL JR. DRIVE SE
Provider Second Line Business Practice Location Address:
WOMEN'S HEALTH CENTER
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30303-3030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-616-1000
Provider Business Practice Location Address Fax Number:
404-616-8065
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  LD001689 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 693593384A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 693593384B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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