Healthcare Provider Details

I. General information

NPI: 1720626799
Provider Name (Legal Business Name): CARA NELL BLENKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 RONALD REAGAN BLVD STE 240
CUMMING GA
30041-6289
US

IV. Provider business mailing address

2860 RONALD REAGAN BLVD STE 240
CUMMING GA
30041-6289
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-0743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10067
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: