Provider Demographics
NPI:1437675394
Name:BLUMBERG, JOY THERESA (NP-C)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:THERESA
Last Name:BLUMBERG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 GREENCASTLE RD
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2936
Mailing Address - Country:US
Mailing Address - Phone:770-487-7807
Mailing Address - Fax:
Practice Address - Street 1:190 GREENCASTLE RD
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2936
Practice Address - Country:US
Practice Address - Phone:770-487-7807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN217517363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner