Provider Demographics
NPI:1083892111
Name:BLATT, JACOB NATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:NATHAN
Last Name:BLATT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-424-6893
Mailing Address - Fax:770-528-9926
Practice Address - Street 1:1700 HOSPITAL SOUTH DR
Practice Address - Street 2:SUITE 409
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6810
Practice Address - Country:US
Practice Address - Phone:770-424-6893
Practice Address - Fax:770-528-9926
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2019-11-15
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Provider Licenses
StateLicense IDTaxonomies
GA057935207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA859089115BMedicaid
GA859089115CMedicaid
GA859089115DMedicaid
GA859089115AMedicaid
GA859089115CMedicaid