Kizuwanda Blackburne in Stockbridge - Physician Assistant
Kizuwanda Blackburne - NPI 1417020405
Kizuwanda Blackburne is a Physician Assistant in Stockbridge, Georgia. Kizuwanda Blackburne practices all healthcare services and medical treatments related to Physician Assistant. The NPI Number for Kizuwanda Blackburne is 1417020405. The last update date is 2008-04-01.
Kizuwanda Blackburne's current location address is 145 Eagles Walk, Stockbridge, Georgia. You can contact this provider via phone number 7703893855 and fax number 7704748078. The mailing address for Kizuwanda Blackburne is 145 Eagles Walk, Stockbridge, Georgia. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Kizuwanda Blackburne |
|---|---|
| Address | 145 Eagles Walk, Stockbridge, Georgia |
| Phone Number | 7703893855 |
| Fax Number | 7704748078 |
| Sole Proprietor | N |
| Credentials | RPAC |
NPI Number Detail
| NPI Number | 1417020405 |
|---|---|
| Provider Enumeration Date | 2006-11-16 |
| Last Updated Date | 2008-04-01 |
Provider Mailing Address Detail
| Address | 145 Eagles Walk |
|---|---|
| City | Stockbridge |
| State | Georgia (GA) |
| Post Code | 302817340 |
| Phone Number | 7703893855 |
| Fax Number | 7704748078 |
Provider's Primary Taxonomy Detail
| Speciality | Physician Assistant |
|---|---|
| Taxonomy | 363A00000X |
| Licence No | 5126 |
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Definition: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perfor |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 61407 | GA | BCBS OF GA GROUP # |
Post Comment/ Review Below
What is the Kizuwanda Blackburne's unique identification number?
The Kizuwanda Blackburne has been assigned the NPI (National Provider Identifier) Number 1417020405 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for the organization.
Could you kindly provide the complete physical address where Kizuwanda Blackburne's facilities are geographically located?
The facilities of Kizuwanda Blackburne are physically situated at the following location: 145 Eagles Walk, Stockbridge, GA, 302817340.
What is the Kizuwanda Blackburne's specialty and taxonomy code?
The Kizuwanda Blackburne's specialty is Physician Assistant, and the corresponding taxonomy code is 363A00000X.
On what date did Kizuwanda Blackburne receive its 1417020405 assignment from the Centers for Medicare & Medicaid Services?
The Kizuwanda Blackburne was assigned its 1417020405 on 2006-11-16, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
When was the information related to Kizuwanda Blackburne most recently updated or refreshed?
The details pertaining to the Kizuwanda Blackburne, including its address, specialty, and other relevant information, were last updated or refreshed on 2008-04-01.