Provider Demographics
NPI:1558501684
Name:BLANDINO, JAIME ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:ANNE
Last Name:BLANDINO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N MCDONOUGH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3317
Mailing Address - Country:US
Mailing Address - Phone:404-313-0464
Mailing Address - Fax:
Practice Address - Street 1:111 N MCDONOUGH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3317
Practice Address - Country:US
Practice Address - Phone:404-313-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003040103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical