Provider Demographics
NPI:1225830987
Name:BLUNT, DESIREE M
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:M
Last Name:BLUNT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1862 AUBURN RD STE 118N2
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1676
Mailing Address - Country:US
Mailing Address - Phone:770-415-3319
Mailing Address - Fax:
Practice Address - Street 1:1862 AUBURN RD STE 118N2
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1676
Practice Address - Country:US
Practice Address - Phone:770-415-3319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant