| Kimberly Patton Blasingame, CNM | |
| 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 | |
| (770) 297-2200 | |
| (770) 534-8139 | 
| Full Name | Kimberly Patton Blasingame | 
|---|---|
| Gender | Female | 
| Speciality | Advanced Practice Midwife | 
| Location | 725 Jesse Jewell Pkwy Se, Gainesville, Georgia | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1184662280 | NPI | - | NPPES | 
| 000773649J | Medicaid | GA | |
| 000773649F | Medicaid | GA | |
| 000773649K | Medicaid | GA | |
| 329086 | Other | GA | WELLCARE | 
| 10044863 | Other | GA | AMERIGROUP | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 367A00000X | Advanced Practice Midwife | RN093785 (Georgia) | Primary | 
| Entity Name | The Longstreet Clinic, Pc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1326019977 PECOS PAC ID: 2668465733 Enrollment ID: O20040405001521 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Kimberly Patton Blasingame, CNM Po Box 658, Gainesville, GA 30503-0658 Ph: (770) 718-1122 | Kimberly Patton Blasingame, CNM 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 Ph: (770) 297-2200 | 
| Vivian Clare Gradin, CNM Advanced Practice Midwife Medicare: Not Enrolled in Medicare Practice Location: 725 Jesse Jewell Pkwy Se, Suite 200, Gainesville, GA 30501 Phone: 770-297-2200 Fax: 770-534-8139 | |
| Amanda Turner Driskell, RN, CNM Advanced Practice Midwife Medicare: Medicare Enrolled Practice Location: 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501 Phone: 770-297-2200 Fax: 770-534-8139 | |
| Ruth Sherry, CNM Advanced Practice Midwife Medicare: Not Enrolled in Medicare Practice Location: 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501 Phone: 770-297-2200 Fax: 770-534-8139 | |
| Destiny D Gilder, CNM Advanced Practice Midwife Medicare: Medicare Enrolled Practice Location: 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501 Phone: 770-297-2200 Fax: 770-534-8139 | |
| Diane S Tandy, CNM Advanced Practice Midwife Medicare: Not Enrolled in Medicare Practice Location: 1285 Sims St, Gainesville, GA 30501 Phone: 770-536-0149 Fax: 770-536-0317 | |
| Sally A. Monroe, CNM Advanced Practice Midwife Medicare: Accepting Medicare Assignments Practice Location: 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501 Phone: 770-297-2200 Fax: 770-534-8139 |