Provider Demographics
NPI:1134448715
Name:BLENCH, ANNE KAGEY (PA-AA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:KAGEY
Last Name:BLENCH
Suffix:
Gender:F
Credentials:PA-AA
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:DIAMOND
Other - Last Name:KAGEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-AA
Mailing Address - Street 1:PO BOX 551420
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1420
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:855-851-4405
Practice Address - Street 1:1968 PEACHTREE RD., NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-351-1745
Practice Address - Fax:404-351-7121
Is Sole Proprietor?:No
Enumeration Date:2010-05-22
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367H00000X
GA005911367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA735072500AMedicaid
GA003100366BMedicaid
GA003100366BMedicaid