Provider Demographics
NPI:1326244856
Name:BLAYLOCK, AKILAH S (PT)
Entity Type:Individual
Prefix:
First Name:AKILAH
Middle Name:S
Last Name:BLAYLOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7248 PARKLAND BND
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-5435
Mailing Address - Country:US
Mailing Address - Phone:404-759-9288
Mailing Address - Fax:
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-0917
Practice Address - Country:US
Practice Address - Phone:404-352-1015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23789225100000X
GAPT009057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist