| Organization Name: | DR JOHNNY J DI BLASI DO PC |
| NPI Number: | 1013378165 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHNNY J DI BLASI (OWNER) |
| Mailing Address: | 3 Washington Ave Gainesville |
| State: | GA US |
| Postal Code: | 305014135 |
| Phone Number: | 9044829673 |
| Fax Number: | |
| NPI Enumeration Date: | 03/17/2016 |
| NPI Last Update Date: | 03/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 75206 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |