Healthcare Provider Details

I. General information

NPI: 1336303825
Provider Name (Legal Business Name): KAREN FOSTER BLACKBURN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 PIEDMONT AVE NE STE D
ATLANTA GA
30303-2417
US

IV. Provider business mailing address

141 PIEDMONT AVE NE STE D
ATLANTA GA
30303-2417
US

V. Phone/Fax

Practice location:
  • Phone: 404-413-1930
  • Fax: 404-413-1953
Mailing address:
  • Phone: 404-413-1930
  • Fax: 404-413-1953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN152997
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: