Basic Information
| Provider Information | |||||||||
| NPI: | 1598249211 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLACKSTOCK | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | TURNER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4840 CHAPEL HILL RD | ||||||||
| Address2: | |||||||||
| City: | DOUGLASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301354910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122225089 | ||||||||
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| Practice Location | |||||||||
| Address1: | 61 WHITCHER ST NE STE 3110 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704222326 | ||||||||
| FaxNumber: | 7714227797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2018 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC0200X | 224434 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine |
No ID Information.