Most Relevant Information
Provider Data
| NPI Number: | 1003349671 |
| Provider Name: | MARY BLALOCK |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | RN129711 |
Most Important Dates
| Enumeration Date: | 04/10/2017 |
| Last Updated: | 04/10/2017 |
Provider Practice Location
107 LAKE RESERVE WAY
HOLLY SPRINGS
GA
301154785
Practice Location Phone/Fax
| Phone: | 7703540471 |
| Fax: |
Provider Mailing Location
107 LAKE RESERVE WAY
HOLLY SPRINGS
GA
301154785
Provider Mailing Phone/Fax
| Phone: | 7703540471 |
| Fax: |