Healthcare Provider Details

I. General information

NPI: 1578986568
Provider Name (Legal Business Name): MARCI BLEVINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 HIGHWAY 136
TRENTON GA
30752-2909
US

IV. Provider business mailing address

4580 HIGHWAY 136
TRENTON GA
30752-2909
US

V. Phone/Fax

Practice location:
  • Phone: 706-657-4777
  • Fax: 706-657-2034
Mailing address:
  • Phone: 706-657-4777
  • Fax: 706-657-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: