W KENNY BLAKE MD LLC NPI 1093011314

NPI Information

  • NPI: 1093011314
  • Provider Name: W KENNY BLAKE MD LLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Address: 545 VENTURE COURT
    MONTICELLO, GA
    ZIP 31064
  • Phone: (706) 468-7002

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NPI Details

W KENNY BLAKE MD LLC is a family medicine in Monticello, GA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. W KENNY BLAKE MD LLC NPI is 1093011314. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

545 VENTURE COURT
MONTICELLO, GA
ZIP 31064
Phone: (706) 468-7002
Fax: (706) 468-7020

The provider's authorized official is Wyatt K Blake .
The authorized official title is Owner and has the following contact phone number (706) 468-7002.

The enumeration date for this NPI number is 2/3/2011 and was last updated on 2/4/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineGEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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