Individual
KATHRYN BLEVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 353-6124
(229) 353-7722
Mailing address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 353-6124
(229) 353-7722
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005805
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005805
LICENSE NUMBER
GA
Enumeration date
07/12/2010
Last updated
11/19/2020
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