Provider Demographics
NPI:1932093473
Name:BLAKE-HENRY, JEWEL (LPN)
Entity type:Individual
Prefix:
First Name:JEWEL
Middle Name:
Last Name:BLAKE-HENRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MULLEN CT
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-2500
Mailing Address - Country:US
Mailing Address - Phone:404-210-4247
Mailing Address - Fax:
Practice Address - Street 1:520 MULLEN CT
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-2500
Practice Address - Country:US
Practice Address - Phone:404-210-4247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN098388164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse