Provider Demographics
NPI:1124201249
Name:LAGRANGE FAMILY MEDICINE
Entity Type:Organization
Organization Name:LAGRANGE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RASHAWN
Authorized Official - Middle Name:MANN
Authorized Official - Last Name:BLAKENEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-845-7029
Mailing Address - Street 1:303 MEDICAL DR
Mailing Address - Street 2:STE 406
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4169
Mailing Address - Country:US
Mailing Address - Phone:706-845-7029
Mailing Address - Fax:706-812-1797
Practice Address - Street 1:303 MEDICAL DR
Practice Address - Street 2:STE 406
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4169
Practice Address - Country:US
Practice Address - Phone:706-845-7029
Practice Address - Fax:706-812-1797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty