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General NPI Number Information
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NPI Number | 1235049255
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Entity Type | Individual
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Provider Name | JESSICA BLACKBURN
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Gender | Female
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 2200 MEDICAL CENTER BLVD STE 200
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7765
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Country | US
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Telephone | 404-845-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 891 WINDING ROSE DR
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City | HOSCHTON
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State | GA
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Zip | 30548-4450
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Country | US
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Telephone | 678-449-4375
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 324419
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License Number State | GA
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