Provider Demographics
NPI:1023008521
Name:BLANKS, EVELINN SUAREZ (WHNP)
Entity type:Individual
Prefix:
First Name:EVELINN
Middle Name:SUAREZ
Last Name:BLANKS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 CROWN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7111
Mailing Address - Country:US
Mailing Address - Phone:770-519-0077
Mailing Address - Fax:
Practice Address - Street 1:83 UPPER RIVERDALE RD SW BLDG 2
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2636
Practice Address - Country:US
Practice Address - Phone:770-991-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118524363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health