Individual
AMANDA BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.T.
Contact information
Practice address
3300 NORTHEAST EXPY NE, BUILDING 8, SUITE C, ATLANTA, GA 30341-3932
(770) 500-3848
Mailing address
3300 NORTHEAST EXPY NE, BUILDING 8, SUITE C, ATLANTA, GA 30341-3932
(770) 500-3848
(678) 868-1114
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT008401
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT008401
STATE LISC NUMBER
GA
Enumeration date
11/08/2006
Last updated
07/29/2009
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