DR. Wyatt Kenny Blake, MD

NPI #1548263064 in Gray, Georgia

Provider Information

NPI Number: 1548263064
Entity Type: Individual
Name: DR. Wyatt Kenny Blake, MD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Family Medicine
Credential: MD
Enumeration Date: May 30, 2005
Last Updated: Jul 17, 2019

Practice Location

Address: 1005 BOULDER DR
City: Gray
State: Georgia
ZIP Code: 31032
Phone: (478) 621-2100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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