Amanda Puckett Blake, CNM

Midwife · Austell, GA

Individual Active NPI

NPI number 1144053596

Practice location

1791 Mulkey Rd Ste 200
Austell, GA 30106-1124

Phone: (770) 732-5400

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NPI record

NPI: 1144053596
Entity type: Individual (Type 1)
Enumeration date: August 21, 2024
Last updated: August 21, 2024
Certified: August 21, 2024
Sole proprietor: No

Specialties & taxonomy codes

Taxonomy	Code	License	State
Midwife Primary	`176B00000X`	RN173764	GA

Mailing address

42 Shoals Trl
Dallas, GA 30132-6045

Phone: (404) 275-0054

Other practice locations (1)

120 Greystone Power Blvd, Dallas, GA 30157-8297 · (678) 945-8345

About Amanda Blake

Amanda Puckett Blake, CNM is a healthcare provider registered in the NPI registry with the primary taxonomy Midwife (code 176B00000X). The practice location is 1791 Mulkey Rd Ste 200, Austell, GA 30106-1124. The NPI number 1144053596 was assigned on August 21, 2024 and the record was last updated on August 21, 2024.

Amanda Blake lists a license in the registry: #RN173764 (GA) for Midwife. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Amanda Puckett Blake, CNM?

The NPI number is 1144053596.

What is the phone number of Amanda Blake?

The phone number listed for the practice location is (770) 732-5400.

Where is Amanda Blake located?

1791 Mulkey Rd Ste 200, Austell, GA 30106-1124.

What is the taxonomy code for Amanda Blake?

The primary taxonomy code is 176B00000X – Midwife.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.