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Individual

KIZUWANDA BLACKBURNE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RPAC

Contact information

Practice address
145 EAGLES WALK, SUITE A, STOCKBRIDGE, GA 30281-7340
(770) 389-3855
(770) 474-8078
Mailing address
145 EAGLES WALK, SUITE A, STOCKBRIDGE, GA 30281-7340
(770) 389-3855
(770) 474-8078

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5126
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
061407
BCBS OF GA GROUP #
GA
Enumeration date
11/16/2006
Last updated
04/01/2008
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