Provider Demographics
NPI:1871679795
Name:BLACKMAN, GINA M (MED)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 PINEYWOODS RD
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-3559
Mailing Address - Country:US
Mailing Address - Phone:706-436-0029
Mailing Address - Fax:706-376-1809
Practice Address - Street 1:272 PINEYWOODS RD
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-3559
Practice Address - Country:US
Practice Address - Phone:706-436-0029
Practice Address - Fax:706-376-1809
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator