Provider Demographics
NPI:1790171460
Name:BLAIR, GEORGIA LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:LEIGH
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:GEORGIA
Other - Middle Name:LEIGH
Other - Last Name:SANIUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1600 W COLLEGE ST STE 540
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3589
Mailing Address - Country:US
Mailing Address - Phone:817-481-5863
Mailing Address - Fax:817-329-8561
Practice Address - Street 1:1600 W COLLEGE ST STE 540
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:817-481-5863
Practice Address - Fax:817-329-8561
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2239207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology