Provider Demographics
NPI:1912496498
Name:BLANKS, VALENCIA L
Entity Type:Individual
Prefix:
First Name:VALENCIA
Middle Name:L
Last Name:BLANKS
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 1:5559 ROCK RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-1049
Mailing Address - Country:US
Mailing Address - Phone:770-990-9503
Mailing Address - Fax:
Practice Address - Street 1:5559 ROCK RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-1049
Practice Address - Country:US
Practice Address - Phone:770-990-9503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0000062445251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health