Healthcare Provider Details

I. General information

NPI: 1043382641
Provider Name (Legal Business Name): MARGARET ANNE BLACKWELL RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 SUNSET AVE NW
ATLANTA GA
30314
US

IV. Provider business mailing address

99 JESSE HILL JR DRIVE SE ROOM 402
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-730-4666
  • Fax: 404-224-3104
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN029925
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: