Provider Demographics
NPI:1588039275
Name:BLEVINS, ALAINA (MSPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:ALAINA
Middle Name:
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 PHARR RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:678-206-2388
Mailing Address - Fax:404-841-9038
Practice Address - Street 1:240 PHARR RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305
Practice Address - Country:US
Practice Address - Phone:678-206-2388
Practice Address - Fax:404-841-9038
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7840363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant