Blake Anthony Landry, PA-C

NPI #1134477524 in Hiram, Georgia

Provider Information

NPI Number: 1134477524
Entity Type: Individual
Name: Blake Anthony Landry, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Aug 16, 2012
Last Updated: Oct 30, 2019

Practice Location

Address: 148 BILL CARRUTH PKWY STE 100
City: Hiram
State: Georgia
ZIP Code: 30141-3756
Phone: (770) 422-1372

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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