Provider Demographics
NPI:1972619161
Name:BLAND, MERRYL LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MERRYL
Middle Name:LYNNE
Last Name:BLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1310 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2335
Mailing Address - Country:US
Mailing Address - Phone:706-257-7205
Mailing Address - Fax:706-653-6645
Practice Address - Street 1:1310 13TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2335
Practice Address - Country:US
Practice Address - Phone:706-257-7205
Practice Address - Fax:706-653-6645
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11968207R00000X
MDD0032091207R00000X
DCMD30474207R00000X
VA0101057461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine