GARRETT BLALOCK (NPI# 1558739003) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558739003 |
| Entity Type | Individual |
| Full Name | GARRETT BLALOCK |
| Credential | PA-C |
| Practice Address |
901 18th St E Tifton GA 31794-3648 |
| Mailing Address |
2081 Chula Brookfield Rd Tifton GA 31794-2662 |
| Practice Telephone | 2293536051 |
| Mailing Telephone | 2294024430 |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2015-09-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
7724 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
901 18TH ST E |
| City | TIFTON |
| State | GA |
| Zip Code | 31794-3648 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003819467 | William A Guest | Internal Medicine | 901 18th St E, Tifton, GA 31794-3648 | 2005-05-31 |
| 1881203305 | Tift Regional Health System Inc | Family Medicine | 901 18th St E, Tifton, GA 31794-3648 | 2020-07-30 |
| 1306466206 | Southwell Ambulatory Inc | Clinic/Center | 901 18th St E, Tifton, GA 31794-3648 | 2020-04-21 |
| 1407481146 | Justin Hugh Roberts | Physician Assistant | 901 18th St E, Tifton, GA 31794-3648 | 2020-03-03 |
| 1558992479 | Justin Giddens | Nurse Anesthetist, Certified Registered | 901 18th St E, Tifton, GA 31794-3648 | 2020-01-29 |
| 1629617147 | Taylor Burrage | Dietitian, Registered | 901 18th St E, Tifton, GA 31794-3648 | 2020-01-01 |
| 1871155002 | Christina Lynn Davis | Nurse Practitioner | 901 18th St E, Tifton, GA 31794-3648 | 2019-07-09 |
| 1306323415 | Lorenzo Gomez | Dietitian, Registered | 901 18th St E, Tifton, GA 31794-3648 | 2018-07-21 |
| 1720564677 | Erin Elizabeth Clemmons | Dietitian, Registered | 901 18th St E, Tifton, GA 31794-3648 | 2018-07-13 |
| 1851891063 | Sarah Loepker | Nurse Practitioner | 901 18th St E, Tifton, GA 31794-3648 | 2018-02-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234043 | Deloris Lunsford | Licensed Practical Nurse | 903 Washington St., Tifton, GA 31794 | 2020-01-17 |
| 1194383075 | William Jordan Kinnett | Registered Nurse | 1205 Tift Ave N, Tifton, GA 31794 | 2019-06-05 |
| 1598321200 | Courtlyn Christanna Fussell | Pharmacist | 2201 Hwy 41 N, Tifton, GA 31794 | 2019-05-17 |
| 1376027722 | Martha Gibbs | Nurse Practitioner | Affinity Clinic/west Campus, 2225 Us Hwy 41 North, Tifton, GA 31794 | 2018-09-21 |
| 1427541044 | Rebekah F Cottle | Speech-Language Pathologist | 2227 Highway 41 North, Tifton, GA 31794 | 2018-06-08 |
| 1790280857 | Tift Regional Health System Inc | Ophthalmology | 1803 Old Ocilla Road, Tifton, GA 31794 | 2018-03-29 |
| 1568975431 | Skyler Clark | Pharmacist | 2201 North 12th Street, Tifton, GA 31794 | 2017-11-14 |
| 1538606306 | Imagine Peace Counseling LLC | Counselor | 223 E 2nd Street, Suite B, Tifton, GA 31794 | 2017-01-31 |
| 1073056347 | Jessica Tumbling | Contractor | 219 Savannah Way, Tifton, GA 31794 | 2016-11-18 |
| 1992159503 | Joseph Thomas Seagraves Jr. | Nurse Practitioner | 901 East 18th Street, Tifton, GA 31794 | 2016-04-20 |
| Find all providers in zip 31794 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598042616 | Maureen Johnson | Physician Assistant | 1401 Tift Ave N, Suite B, Tifton, GA 31794-3585 | 2011-11-03 |
| 1508930082 | Terry Lee Morgan | Physician Assistant | 1111 20th St E, Tifton, GA 31794-3689 | 2006-11-17 |
| 1033149398 | Kimmie A Carden | Physician Assistant | 2735 Central Ave S, Tifton, GA 31794-5645 | 2006-07-03 |
| 1073576930 | Treasure F Payne | Physician Assistant | 39 Kent Rd, Suite 5, Tifton, GA 31794-1649 | 2006-04-10 |
| 1629062724 | Jerry Sullivan | Physician Assistant | 2225 Us Highway 41 N, Tifton, GA 31794-2749 | 2005-09-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245838374 | Erica Elizabeth West | Physician Assistant | 1155 Mount Vernon Hwy Ste 101, Atlanta, GA 30338-5439 | 2020-10-12 |
| 1801402888 | Meredith Gaines | Physician Assistant | 603 W 1st St Unit 1, Rome, GA 30161-3067 | 2020-09-16 |
| 1770108805 | Kelsey Lynne Greeff | Physician Assistant | 3400 Old Milton Pkwy Ste C, Alpharetta, GA 30005-3707 | 2020-06-15 |
| 1518596733 | Rebecca Faye Tsyrlin | Physician Assistant | 2655 Dallas Hwy Sw Ste 340, Marietta, GA 30064-7518 | 2020-04-08 |
| 1487291878 | Ashley Cohen | Physician Assistant | 250 E Ponce De Leon Ave Ste 800, Decatur, GA 30030-3438 | 2019-12-04 |
| 1932757606 | Andrea J Holley | Physician Assistant | 1629 Austin Meadows Dr, Decatur, GA 30032-3888 | 2019-08-27 |
| 1265089759 | Alexis Chester Jones | Physician Assistant | 3000 Old Alabama Rd # 128, Johns Creek, GA 30022-5860 | 2019-08-20 |
| 1841851680 | Lauren Price Fogarty | Physician Assistant | 5445 Meridian Marks Rd Ste 430, Atlanta, GA 30342-4755 | 2019-06-24 |
| 1386208262 | Jessica A Drews | Physician Assistant | 2342 Cortez Way Ne, Brookhaven, GA 30319-3914 | 2019-04-26 |
| 1174187421 | Krisna Patel | Physician Assistant | 1805 Honey Creek Cmns Se Ste B, Conyers, GA 30013-5829 | 2019-04-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.