Healthcare Provider Details

I. General information

NPI: 1417896895
Provider Name (Legal Business Name): TAMEKA BLACKMON REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 WYNBROOKE PKWY
STONE MOUNTAIN GA
30087-4763
US

IV. Provider business mailing address

508 WYNBROOKE PKWY
STONE MOUNTAIN GA
30087-4766
US

V. Phone/Fax

Practice location:
  • Phone: 404-449-7185
  • Fax:
Mailing address:
  • Phone: 404-449-7185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberRN323944
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: