Provider Demographics
NPI:1942248729
Name:BLATT, HERBERT L (MD, JD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:L
Last Name:BLATT
Suffix:
Gender:M
Credentials:MD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30133-2010
Mailing Address - Country:US
Mailing Address - Phone:770-949-3885
Mailing Address - Fax:770-949-3882
Practice Address - Street 1:6001 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 2000
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5602
Practice Address - Country:US
Practice Address - Phone:770-949-3885
Practice Address - Fax:770-949-3882
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020964207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00190495AMedicaid
D28947Medicare UPIN