Individual
EBONY BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
80 JESSE HILL JR DR SE, ATLANTA, GA 30303-3031
(404) 616-6419
Mailing address
3817 NORTHUMBERLAND DR, LOUISVILLE, KY 40245-1890
(502) 641-7689
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/14/2013
Last updated
11/14/2013
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