Provider Demographics
NPI:1326144239
Name:BLAKENEY, RASHAWN M (MD)
Entity Type:Individual
Prefix:
First Name:RASHAWN
Middle Name:M
Last Name:BLAKENEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RASHAWN
Other - Middle Name:LANELL
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3624 J DEWEY GRAY CIR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6584
Mailing Address - Country:US
Mailing Address - Phone:706-855-5650
Mailing Address - Fax:706-863-0821
Practice Address - Street 1:3634 J DEWEY GRAY CIR
Practice Address - Street 2:SUITE 308
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6580
Practice Address - Country:US
Practice Address - Phone:706-855-5650
Practice Address - Fax:706-863-0821
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA704247972CMedicaid
H91960Medicare UPIN