Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 224434 | GA |
NPI | 1598249211 |
---|---|
Provider Name | Mrs. Sarah Turner Blackstock |
First Address | Douglasville, GA 30135-4910 |
Second Address | Marietta, GA 30060-1179 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2018 |
Last Update Date | 18/09/2018 |