Healthcare Provider Details

I. General information

NPI: 1336002617
Provider Name (Legal Business Name): MARIAMA BLACKMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 ARROWHEAD BLVD
JONESBORO GA
30236-1106
US

IV. Provider business mailing address

236 ARROWHEAD BLVD
JONESBORO GA
30236-1106
US

V. Phone/Fax

Practice location:
  • Phone: 770-478-9240
  • Fax:
Mailing address:
  • Phone: 678-592-1372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberAPRN-NP281438
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: