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Individual

MARY REBECCA BLACKINGTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
11525 HAYNES BRIDGE RD STE 200, ALPHARETTA, GA 30009-4822
(770) 751-0800
(770) 751-1401
Mailing address
11525 HAYNES BRIDGE RD STE 200, ALPHARETTA, GA 30009-4822
(770) 751-0800
(770) 751-1401

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
051424
GA
208000000X
Pediatrics Physician
Primary
43554
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003134985C
GA
Enumeration date
10/02/2006
Last updated
10/14/2020
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