| Doctor Name: | DR. GISELLE DEVONNE BLAIR |
| NPI Number: | 1013276708 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 074805 |
| Business Practice Address: | 925 Branch Ct Ste. 201 Grovetown, GA - 308133325 |
| Business Phone Number: | 7067747263 |
| Business Fax Number: | 7067747230 |
| Mailing Address: | University Medical Group, Llc, P O Box 1705 AUGUSTA |
| State: | GA |
| Postal Code: | 309031705 |
| Phone Number: | 7068546917 |
| Fax Number: | 7067747279 |
| NPI Enumeration Date: | 05/15/2012 |
| NPI Last Update Date: | 04/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 193200000X |
| License Number: | 074805 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Group |
| Taxonomy Classification: | Multi-Specialty |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A business group of one or more individual practitioners, who practice with different areas of specialization. |