Provider Demographics
NPI:1598874471
Name:BLACKBURN, ANDREW JAMES (PAC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 PEACHTREE RD STE 200
Mailing Address - Street 2:CAROLINA MOUNTAIN EMERGENCY MEDICINE, PA
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3160
Mailing Address - Country:US
Mailing Address - Phone:828-277-7772
Mailing Address - Fax:828-277-1117
Practice Address - Street 1:509 BILTMORE AVE
Practice Address - Street 2:MEMORIAL MISSION HOSPITAL
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4601
Practice Address - Country:US
Practice Address - Phone:828-213-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103258363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P32162Medicare UPIN
NC2756279Medicare PIN