Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Blake Family Medicine PLLC

Organization Family Medicine Physician · NPI 1295959310

Blake Family Medicine PLLC is a Family Medicine Physician in Shallotte, North Carolina. Licensed in North Carolina. Registered with an NPI since 2007.

Licensed in
NC
In the registry since
2007
Specialties on file
3
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

4704 Main St
Shallotte, NC 28470-1880
Phone: (910) 754-4545
Fax: (910) 754-4794
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 10868 (NC)
Physician Assistant Taxonomy 363A00000X · Licence 103290 (NC)
Physician Assistant Taxonomy 363A00000X · Licence 103296 (NC)

Record details

NPI number1295959310
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official John Blake — Owner · (910) 754-4545
NPI enumeratedApril 12, 2007
Last updated in NPPESSeptember 11, 2025
Mailing addressPo Box 3206, Shallotte, NC 28459-3206

Other providers in Shallotte