Provider Demographics
NPI:1760667265
Name:BLASH, ALAYNA M (DPM)
Entity Type:Individual
Prefix:
First Name:ALAYNA
Middle Name:M
Last Name:BLASH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ALAYNA
Other - Middle Name:JOSEPH
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 17881
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-0881
Mailing Address - Country:US
Mailing Address - Phone:404-827-9362
Mailing Address - Fax:
Practice Address - Street 1:1318 MCPHERSON AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-1608
Practice Address - Country:US
Practice Address - Phone:404-827-9362
Practice Address - Fax:404-827-9362
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000967213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist