Healthcare Provider Details

I. General information

NPI: 1821488446
Provider Name (Legal Business Name): ERIN BLALOCK APRN - PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 WATER PL SE STE 250
ATLANTA GA
30339-2287
US

IV. Provider business mailing address

136 BOSTON RD
CALHOUN GA
30701-2207
US

V. Phone/Fax

Practice location:
  • Phone: 404-220-7362
  • Fax: 678-213-1609
Mailing address:
  • Phone: 678-982-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN203918
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN203918
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: