Provider Demographics
NPI:1831253814
Name:BLATT, ANDREW DOUGLAS (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DOUGLAS
Last Name:BLATT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3534 OLD MILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4459
Mailing Address - Country:US
Mailing Address - Phone:678-624-0310
Mailing Address - Fax:678-624-0258
Practice Address - Street 1:3534 OLD MILTON PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4459
Practice Address - Country:US
Practice Address - Phone:678-624-0310
Practice Address - Fax:678-624-0258
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002845103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical