Individual
EVAN BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1180 SATELLITE BLVD NW, SUITE 100, SUWANEE, GA 30024-4636
(404) 367-2080
(770) 495-3493
Mailing address
1180 SATELLITE BLVD NW, SUITE 100, SUWANEE, GA 30024-4636
(404) 367-2080
(770) 495-3493
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT005107
GA
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005107
LICENSE #
GA
Enumeration date
08/23/2006
Last updated
11/22/2013
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