W KENNY BLAKE MD LLC (NPI# 1093011314) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093011314 |
| Entity Type | Organization |
| Organization Name | W KENNY BLAKE MD LLC |
| Practice Address |
545 Venture Court Monticello GA 31064 |
| Practice Telephone | 7064687002 |
| Practice Fax Number | 7064687020 |
| Mailing Telephone | 7064687002 |
| Mailing Fax Number | 7064687020 |
| Enumeration Date | 2011-02-03 |
| Last Update Date | 2011-02-04 |
| Authorized Official Name | WYATT K BLAKE (OWNER) |
| Authorized Official Telephone | 7064687002 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | GA | Allopathic & Osteopathic Physicians |
| Street Address |
545 VENTURE COURT |
| City | MONTICELLO |
| State | GA |
| Zip Code | 31064 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295738722 | Shannon T Barton | Family Medicine | 545 Venture Court, Monticello, GA 31064 | 2005-05-30 |
| 1811293137 | Shannon T. Barton Md LLC | Family Medicine | 545 Venture Court, Monticello, GA 31064 | 2011-02-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568935757 | Neighborcare Pharmacy | Pharmacy | 3 Short St., Monticello, GA 31064 | 2019-01-10 |
| 1932563178 | Mary Catherine Sikes | Specialist/Technologist | 126 Hwy 212 West, Monticello, GA 31064 | 2016-04-13 |
| 1801018288 | Griswold Chiropractic | Chiropractor | 111 W. Washington St, Monticello, GA 31064 | 2007-05-03 |
| 1881733392 | Garrett Medical Supplies | Durable Medical Equipment & Medical Supplies | 126 Greene Street, Montilcello, GA 31064 | 2007-02-05 |
| 1629189212 | Stephen R Griswold | Chiropractor | 111 West Washington St, Monticello, GA 31064 | 2006-08-31 |
| 1144293457 | Jamie Alan Mitchell | Dentist | 458 W Washington St, Monticello, GA 31064 | 2006-02-08 |
| 1609859818 | Jasper County Emergency Medical Service | Ambulance | 185 Highway 212 W, Monticello, GA 31064-0000 | 2005-11-22 |
| 1275739914 | Heritage Medical Equipment | Durable Medical Equipment & Medical Supplies | 126 E Greene St, Monticello, GA 31064-1008 | 2007-06-21 |
| 1275636037 | Georgia Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 330 E Greene St, Monticello, GA 31064-1012 | 2006-09-07 |
| 1689684862 | County of Jasper Health Department | Public Health or Welfare | 336 E Greene Street, Monticello, GA 31064-1012 | 2006-08-09 |
| Find all providers in zip 31064 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| 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. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679914675 | Mitchell Hammel | Family Medicine | 100 W Washington St Ste 101, Monticello, IL 61856-1713 | 2013-07-08 |
| 1700225679 | Michael Ray Nielson | Family Medicine | 380 W. 100 North, Monticello, UT 84535 | 2013-06-24 |
| 1740415611 | Julia Danielle Nicholson | Family Medicine | 906 Roberts Drive, Monticello, AR 71655 | 2009-05-21 |
| 1053566232 | Monticello Family Medicine & Walk-in Center | Family Medicine | 10 Prince St Ste 7, Monticello, NY 12701-1919 | 2008-12-01 |
| 1326248774 | James Wyatt Stephens | Family Medicine | 128 Courthouse Sq, Monticello, MS 39654-6014 | 2007-07-24 |
| 1548464993 | Fredy H Cordova | Family Medicine | 766 Hl Ross Dr, Monticello, AR 71655 | 2007-06-11 |
| 1629141494 | Bonita C Musial | Family Medicine | 314 Main St., Suite D, Monticello, MS 39654-0949 | 2006-11-17 |
| 1851463707 | Brantley B. Pace | Family Medicine | 713 Watts St., Monticello, MS 39654 | 2006-11-15 |
| 1790865624 | Christine M Foster | Family Medicine | 1293 N Main St Ste 102, Monticello, KY 42633-1945 | 2006-10-16 |
| 1962598490 | Abraham G. Garfinkel | Family Medicine | 15 Hamilton Ave, Monticello, NY 12701-1319 | 2006-10-04 |
| Find all providers in MONTICELLO | ||||
| City | MONTICELLO |
| Zip Code | 31064 |
Please comment or provide details below to improve the information on W KENNY BLAKE MD LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.