Provider Demographics
NPI:1578986568
Name:BLEVINS, MARCI
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4580 HIGHWAY 136
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-2909
Mailing Address - Country:US
Mailing Address - Phone:706-657-4777
Mailing Address - Fax:706-657-2034
Practice Address - Street 1:4580 HIGHWAY 136
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-2909
Practice Address - Country:US
Practice Address - Phone:706-657-4777
Practice Address - Fax:706-657-2034
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath