Blackburne, Kizuwanda
Blackburne, Kizuwanda is an individual health care provider with primary practice located at 145 Eagles Walk Suite A, Stockbridge GA 30281-7340. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Blackburne, Kizuwanda can be contacted via phone (770) 389-3855.Contact Information
Primary practice address
145 Eagles Walk Suite A
Stockbridge GA 30281-7340
Phone: (770) 389-3855
Fax: (770) 474-8078
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 5126 | Georgia |
Profile Details
| NPI number | 1417020405 |
|---|---|
| LBN Legal business name | Blackburne, Kizuwanda |
| Credentials | RPAC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 16th, 2006 |
| Last updated | Apr 1st, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417020405 | NPPES |
| Georgia | Other | 061407 | BCBS OF GA GROUP # |
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