Provider Demographics
NPI:1831255520
Name:BLANTON, DENEESE (MD, RDN)
Entity type:Individual
Prefix:
First Name:DENEESE
Middle Name:
Last Name:BLANTON
Suffix:
Gender:F
Credentials:MD, RDN
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:DENEESE
Other - Last Name:BLANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 JESSE HILL JR DR SE
Mailing Address - Street 2:WOMEN'S HEALTH CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3050
Mailing Address - Country:US
Mailing Address - Phone:404-616-1000
Mailing Address - Fax:404-616-8065
Practice Address - Street 1:80 JESSE HILL JR. DRIVE SE
Practice Address - Street 2:WOMEN'S HEALTH CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3030
Practice Address - Country:US
Practice Address - Phone:404-616-1000
Practice Address - Fax:404-616-8065
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001689133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA693593384AMedicaid
GA693593384BMedicaid