| Doctor Name: | JAMIE RIVKIN BLALOCK |
| NPI Number: | 1073875902 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, APRN, FNP-C |
| License Number: | RN149435 |
| Business Practice Address: | 123 Weaver Rd Suite A Blairsville, GA - 305123155 |
| Business Phone Number: | 7067459417 |
| Business Fax Number: | 7064396482 |
| Mailing Address: | 123 Weaver Rd, Suite A BLAIRSVILLE |
| State: | GA |
| Postal Code: | 305123155 |
| Phone Number: | 7067459417 |
| Fax Number: | 7064396482 |
| NPI Enumeration Date: | 06/15/2012 |
| NPI Last Update Date: | 06/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN149435 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |