Provider Demographics
NPI:1144455536
Name:BLOUNT, RAY (LNMT)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:BLOUNT
Suffix:
Gender:M
Credentials:LNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 LENOX RD NE
Mailing Address - Street 2:C4
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4733
Mailing Address - Country:US
Mailing Address - Phone:404-226-3590
Mailing Address - Fax:
Practice Address - Street 1:1874 PIEDMONT RD NE
Practice Address - Street 2:480D
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4869
Practice Address - Country:US
Practice Address - Phone:404-226-3590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000031225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist