Provider Demographics
NPI:1033752431
Name:GEORGIA L BLAIR MD, PLLC
Entity Type:Organization
Organization Name:GEORGIA L BLAIR MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-481-5863
Mailing Address - Street 1:1600 W COLLEGE ST STE 540
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3589
Mailing Address - Country:US
Mailing Address - Phone:817-481-5863
Mailing Address - Fax:
Practice Address - Street 1:1600 W COLLEGE ST STE 540
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3589
Practice Address - Country:US
Practice Address - Phone:817-481-5863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty