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Dr. Wyatt Kenny Blake, MD
Family Medicine Physician in Gray, Georgia
NPI 1548263064

Wyatt Kenny Blake is a Family Medicine Physician based in Gray, GA. Wyatt Kenny Blake practices in Gray, GA and has the professional credentials of MD. The NPI Number for Wyatt Kenny Blake is 1548263064 and holds a License No. 047702 (Georgia).

The current practice location address for Wyatt Kenny Blake is 1005 Boulder Dr, Gray, GA and can be reached out via phone at 478-621-2100 and via fax at 478-744-0481.

Location: 1005 Boulder Dr, Gray, GA, 31032-6141
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1548263064
Provider Name
Wyatt Kenny Blake
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
1005 Boulder Dr, Gray, GA, 31032-6141
Phone Number
478-621-2100
Fax Number
478-744-0481
Provider Enumeration Date
05/30/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
000909114E 05 GA
843785 01 GA BCBS OF GEORGIA
080176614 01 GA RAILROAD MEDICARE
047702 01 GA GA LICENSE
institution
Provider Business Practice Location Address Details
Address
1005 Boulder Dr
City
Gray
State
Georgia
Zip
31032
Phone Number
478-621-2100
Fax Number
478-744-0481
person
Provider Business Mailing Address Details
Address
1005 Boulder Dr
City
Gray
State
Georgia
Zip
31032
Phone Number
478-621-2100
Fax Number
478-744-0481
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Family Medicine
Speciality
-
Taxonomy
207Q00000X
License No.
047702 (Georgia)
Definition
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.
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