Provider Demographics
NPI:1184128514
Name:BLACKWELL, CHRISTY P
Entity type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:P
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHRISTY
Other - Middle Name:P
Other - Last Name:BLACKWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:4704 GREBE CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-8516
Mailing Address - Country:US
Mailing Address - Phone:706-294-6135
Mailing Address - Fax:
Practice Address - Street 1:4704 GREBE CT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-8516
Practice Address - Country:US
Practice Address - Phone:706-294-6135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170034163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health