Healthcare Provider Details

I. General information

NPI: 1700672110
Provider Name (Legal Business Name): AIDAN ELISE BLANCHARD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 PINE ST STE 500
MACON GA
31201-7530
US

IV. Provider business mailing address

840 PINE ST STE 500
MACON GA
31201-7530
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-8682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13078
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: