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

Blake Anthony Landry, PA-C

Individual provider Physician Assistant · NPI 1134477524

Blake Anthony Landry, PA-C is a Physician Assistant in Hiram, Georgia. Qualified in 2012, 14 years ago. Practices with Wellstar Medical Group LLC, a 3,072-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Alabama and Georgia.

Years since qualifying
14
Licensed in
AL, GA
In the registry since
2012
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

148 Bill Carruth Pkwy Ste 100
Hiram, GA 30141-3756
Phone: (770) 422-1372
Fax: (678) 363-5170
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3719 Dauphin St, Mobile, AL 36608-1753 — (251) 435-7223

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 7061 (GA)
Physician Assistant Taxonomy 363A00000X · Licence TA1743 (AL)

Record details

NPI number1134477524
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedAugust 16, 2012
Last updated in NPPESMay 11, 2026
Certification dateMay 11, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Wellstar Medical Group Llc — 3072 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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