NPI age
20 years
Enumerated 2005-05-30
● Active
Type 1 · Individual
DR. Wyatt Kenny Blake, MD
Blake is 1 of 9 family medicine providers in Gray and 1 of 5448 in Georgia.
Primary specialty
Family Medicine
Licensed in
GA
1 state
Status
Active
No deactivations on record
Last NPPES update
2019-07-17
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 5448 active family medicine providers in Georgia.
NPI age
20 years
↑ 3 yr above median (17 yr)
State licenses
1 state
12% of peers hold multiple states
Subspecialties
0
26% of peers hold subspecialties
NPI lifetime · 2005 → 2026
2005-05Enumerated in NPPES
2005
2026
Where they practice
Practice location
1005 Boulder Dr
Gray, GA 31032
Mailing address
1005 Boulder Dr
Gray, GA 310326141
Additional practice locations
1 secondary location on file with NPPES.
Location 2
4421 Carnes St
Acworth, GA 301015305
Specialties
-
Family Medicine PrimaryFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 000909114E | |
| 01 (GA) | 843785 | BCBS OF GEORGIA |
| 01 (GA) | 080176614 | RAILROAD MEDICARE |
| 01 (GA) | 047702 | GA LICENSE |
Practice context
Part of a multi-provider practice. 23 other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.