Healthcare Provider Details

I. General information

NPI: 1023862067
Provider Name (Legal Business Name): PATRICIA ELAINE BLEVINS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. PATRICIA EDWARDS

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14557 HIGHWAY 19 STE C
GRIFFIN GA
30224-9582
US

IV. Provider business mailing address

519 FIVE POINTS RD
MILNER GA
30257-3903
US

V. Phone/Fax

Practice location:
  • Phone: 770-468-6941
  • Fax: 678-408-9515
Mailing address:
  • Phone: 770-584-1864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP004722
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: