Provider Demographics
NPI:1578533295
Name:LINDBLOOM, ANNE DAVIDSON FURTAH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:DAVIDSON FURTAH
Last Name:LINDBLOOM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2988 SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3033
Mailing Address - Country:US
Mailing Address - Phone:866-825-3227
Mailing Address - Fax:678-279-4921
Practice Address - Street 1:2988 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3033
Practice Address - Country:US
Practice Address - Phone:866-825-3227
Practice Address - Fax:678-279-4921
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN167745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA475948632BMedicaid
GA475948632AMedicaid
GAP00391495OtherRR MEDICARE
GAP17253Medicare UPIN
GA50BBLHGMedicare PIN