Individual
LAURA BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5455 MERIDIAN MARKS RD STE 180, ATLANTA, GA 30342-4716
(404) 785-2849
Mailing address
986 ROSEDALE RD NE, ATLANTA, GA 30306-4831
(978) 621-2219
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY003941
GA
Other
Enumeration date
11/23/2015
Last updated
11/23/2015
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