Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kizuwanda Blackburne, RPAC

Individual provider Physician Assistant · NPI 1417020405

Kizuwanda Blackburne, RPAC is a Physician Assistant in Stockbridge, Georgia. Qualified in 2004, 22 years ago. Practices with The Emory Clinic Inc, a 3,500-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Georgia.

Years since qualifying
22
Licensed in
GA
In the registry since
2006

Practice location Address checks out

145 Eagles Walk Ste A
Stockbridge, GA 30281-7340
Phone: (770) 389-3855
Fax: (770) 474-8078
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5126 (GA)

Record details

NPI number1417020405
Entity typeIndividual (Type 1)
GenderFemale
Credentials RPAC
Sole proprietorNo
NPI enumeratedNovember 16, 2006
Last updated in NPPESApril 1, 2008

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice The Emory Clinic Inc — 3500 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Stockbridge