AMANDA PUCKETT BLAKE CNM
NPI 1144053596
Midwife in Austell, GA

Active since August 21, 2024PECOS Enrolled
1791 MULKEY RD STE 200, AUSTELL, GA 30106(770) 732-5400 Get Directions Write a Review

NPPES record last updated: August 21, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Amanda Puckett Blake Cnm NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AMANDA PUCKETT BLAKE CNM (NPI 1144053596) is an individual midwife in Austell, Georgia, licensed in Georgia (RN173764) and active in the NPI registry since August 2024. She is enrolled in Medicare PECOS and maintains a secondary practice location in Dallas.

NPPES Registry Identity

NPI1144053596
Entity TypeIndividualFemale
Primary Taxonomy176B00000X
Provider Legal NameAMANDA PUCKETT BLAKECredential: CNM
Location Address1791 MULKEY RD STE 200Austell, GA 30106-1124
Mailing Address42 Shoals TrlDallas, GA 30132-6045 · (404) 275-0054
Sole ProprietorNo
Enumeration DateAugust 21, 2024
NPPES CertifiedAugust 21, 2024
✔ NPI 1144053596 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMidwifeOther Service Providers
Taxonomy Code176B00000X
License✔ Licensed in GA · RN173764
Definition
A Midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth, offering expert individualized care, education, counseling, and support to a woman and her newborn throughout the childbearing cycle. A Midwife is a skilled and independent practitioner who has undergone formalized training. Midwives are not required to be nurses and may be trained via multiple routes of education (apprenticeship, workshop, formal classes, or programs, etc., usually a combination). The educational background requirements and licensing requirements vary by state. The Midwife may or may not be certified by a state or national organization.
1791 MULKEY RD STE 200, Austell, GA 30106

Other Names 1

Former Name (1)Amanda Loraine Puckett

Secondary Practice Location 1

Location 1120 Greystone Power BlvdDallas, GA 30157-8297 · Phone (678) 945-8345

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Amanda Puckett Blake Cnm is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Amanda Blake reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Obstetrics & Gynecology
1791 MULKEY RD, SUITE 200
Austell, GA 30106
  • Reassigned Medicare billing, Georgia enrollment
  • 3,885 clinicians in this Medicare group

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Advanced Practice Midwife
1791 MULKEY RD STE 200
AUSTELL, GA 30106
Clinic/Center
1791 MULKEY RD STE 200
AUSTELL, GA 30106
Advanced Practice Midwife
1791 MULKEY RD STE 200
AUSTELL, GA 30106
Nurse Practitioner (Women's Health)
1791 MULKEY RD STE 200
AUSTELL, GA 30106

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Amanda Blake's NPI number?

The NPI number for Amanda Blake is 1144053596. It was assigned to this individual provider in the NPPES registry on August 21, 2024. The provider is also known as Amanda Loraine Puckett.

Where is Amanda Blake located?

Amanda Blake practices at 1791 Mulkey Rd Ste 200, Austell, GA 30106. The listed phone number is (770) 732-5400.

What is Amanda Blake's specialty?

The primary specialty registered for this NPI is Midwife with taxonomy code 176B00000X.

Is Amanda Blake enrolled in Medicare?

Yes. Amanda Blake is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Amanda Blake's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Amanda Blake reassigns Medicare benefits to Wellstar Medical Group, LLC (Austell, GA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Amanda Blake's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Amanda Blake accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama and Ambetter of North Carolina and 1 other insurer list Amanda Blake as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Amanda Blake was last updated on August 21, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.