Active NPI
Heather Marie Blackburn, PA-C
- Physician Assistant
- Homerville, GA
National Provider Identifier
1114910429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5518
- Practice address
- Clinch Memorial Hospital
1050 Valdosta Hwy
Homerville, GA 31634 - Phone
- (912) 487-5211
- Fax
- (912) 487-4332
- NPI assigned
- Aug 23, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5518 | GA | Primary |
Addresses
Primary practice location
Clinch Memorial Hospital
1050 Valdosta Hwy
Homerville, GA 31634
Mailing address
100 S Madison St
Thomasville, GA 31792-5473
Phone (229) 236-0831
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA, NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090512000463 | GA | Practitioner - Physician Assistant | 4880743392 | Reassigns benefits to 11 organizations |
| I20190829003140 | NC | Practitioner - Physician Assistant | 4880743392 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- University of Nebraska College of Medicine, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southland Consolidated Emergency Services LLC
Practice addresses (Care Compare)
163 E Tollison St
Baxley, GA 31513-0120
Phone (912) 367-9841
4 Medical Dr
Elberton, GA 30635-1830
Phone (706) 283-3151
Hospital & facility affiliations
- Clinch Memorial Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.21 of 100
- Quality
- 84.26
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5518 | NC | MD | Chiropractor |
| 5518 | GA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southland Optim Jenkins Emergency Medical Services, LLC | Current | Accepting new patients | |
| Southland-Nashville Emergency Services, LLC | Current | Accepting new patients | |
| Hospital Authority of the City of Bainbridge and Decatur County | Past | Accepting new patients |
Locations
462 Elma G Miles Pkwy
Hinesville, GA 31313
Phone (888) 829-0068
931 E Winthrope Ave
Millen, GA 30442
Phone (478) 982-4221
1221 E McPherson Ave
Nashville, GA 31639
Phone (229) 543-7100
100 S Madison St
Thomasville, GA 31792
Phone (229) 221-9552
Organizations & group practices 15
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Emergency Medicine Physician
- Elberton, GA
- NPI 1174917124
GA
-
- General Acute Care Hospital
- Lakeland, GA
- NPI 1821341397
GA
-
- Emergency Medicine Physician
- Homerville, GA
- NPI 1093223778
GA
-
- Hospitalist Physician
- Cochran, GA
- NPI 1033464391
GA
-
- Emergency Medicine Physician
- Millen, GA
- NPI 1265826242
GA
-
- Emergency Medicine Physician
- Sylvania, GA
- NPI 1174917157
GA
-
- Emergency Medicine Physician
- Nashville, GA
- NPI 1639467038
GA
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786492800000",
"number": "1114910429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 S MADISON ST",
"city": "THOMASVILLE",
"state": "GA",
"postal_code": "317925473",
"telephone_number": "229-236-0831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CLINCH MEMORIAL HOSPITAL",
"address_2": "1050 VALDOSTA HWY",
"city": "HOMERVILLE",
"state": "GA",
"postal_code": "31634",
"telephone_number": "912-487-5211",
"fax_number": "912-487-4332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN",
"first_name": "HEATHER",
"middle_name": "MARIE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-23",
"last_updated": "2026-08-12",
"certification_date": "2026-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "5518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Homerville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.