Healthcare Provider Details

I. General information

NPI: 1760258818
Provider Name (Legal Business Name): BLOWN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 RIVER RD STE 210
COLUMBUS GA
31904-4574
US

IV. Provider business mailing address

6001 RIVER RD STE 210
COLUMBUS GA
31904-4574
US

V. Phone/Fax

Practice location:
  • Phone: 706-708-9090
  • Fax:
Mailing address:
  • Phone: 706-708-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHANEA BUIE
Title or Position: CEO
Credential:
Phone: 706-708-9090