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1598500605
ISRAEL DENNARD BLAKE
THOMASVILLE, GA
NPI
1598500605
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
374K00000X
Additional Taxonomies
101YP1600X Counselor, Pastoral
Enumeration Date
2024-06-28
Last Update Date
2024-06-28
Business Address
Mr. ISRAEL DENNARD BLAKE
228 AUGUSTA AVE
THOMASVILLE, GA 31792-7003
Phone number: 229-228-7775
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Mailing Address
Mr. ISRAEL DENNARD BLAKE
PO BOX 2763
THOMASVILLE, GA 31799-2763
Phone number: 229-228-7775
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