Provider Demographics
NPI:1275748535
Name:BLAKE E. MILNER, M.D. P.C.
Entity Type:Organization
Organization Name:BLAKE E. MILNER, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-374-8998
Mailing Address - Street 1:1111 GRIFFIN AVE
Mailing Address - Street 2:STE. 1B
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-9101
Mailing Address - Country:US
Mailing Address - Phone:478-374-8998
Mailing Address - Fax:478-374-8525
Practice Address - Street 1:1111 GRIFFIN AVE
Practice Address - Street 2:STE. 1B
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-9101
Practice Address - Country:US
Practice Address - Phone:478-374-8998
Practice Address - Fax:478-374-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA170591OtherWELLCARE OF GEORGIA
GA043644539AMedicaid
GA275410OtherPEACH STATE HEALTH PLAN
GA52070342OtherBLUE CROSS BLUE SHIELD OF
GAH39634Medicare UPIN
GAGRP6056Medicare ID - Type Unspecified