Individual
MRS. AIMEE LYNN EBLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
318 W PIKE ST, SUITE 104, LAWRENCEVILLE, GA 30045-3234
(770) 314-1388
(678) 377-2882
Mailing address
1810 MILLSIDE TER, DACULA, GA 30019-3256
(770) 932-6612
(678) 377-2833
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT004663
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00731882C
PEACHSTATE HEALTH PLAN
GA
05
—
00731882C
—
GA
01
—
10037612
AMERIGROUP
GA
01
—
307920
WELLCARE
GA
Enumeration date
10/06/2006
Last updated
07/09/2007
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