Doctor Name: | SONYA LYNN BLACKMON |
NPI Number: | 1841586328 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | 190879 |
Business Practice Address: | 206 E Church St Bowman, GA - 306242109 |
Business Phone Number: | 7062457361 |
Business Fax Number: | |
Mailing Address: | Po Box 459, COLBERT |
State: | GA |
Postal Code: | 306280459 |
Phone Number: | 7067883234 |
Fax Number: | 7067882936 |
NPI Enumeration Date: | 06/23/2011 |
NPI Last Update Date: | 11/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 190879 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |