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General NPI Number Information
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NPI Number | 1023862067
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Entity Type | Individual
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Provider Name | PATRICIA ELAINE BLEVINS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/16/2024
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 14557 HIGHWAY 19 STE C
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City | GRIFFIN
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State | GA
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Zip | 30224-9582
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Country | US
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Telephone | 770-468-6941
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Fax | 678-408-9515
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Provider Business Mailing Address
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Address Line | 519 FIVE POINTS RD
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City | MILNER
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State | GA
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Zip | 30257-3903
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Country | US
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Telephone | 770-584-1864
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP004722
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License Number State | GA
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