Provider Demographics
NPI:1013276708
Name:BLAIR, GISELLE DEVONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:GISELLE
Middle Name:DEVONNE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-1969
Mailing Address - Country:US
Mailing Address - Phone:252-507-0588
Mailing Address - Fax:855-937-0774
Practice Address - Street 1:315 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-1969
Practice Address - Country:US
Practice Address - Phone:252-507-0588
Practice Address - Fax:855-937-0774
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89984495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine