Active NPI
Lisa Dove Blakely, RN
- Administrator Registered Nurse
- Atlanta, GA
National Provider Identifier
1336678317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Administrator Registered Nurse
- License
- RN127654
- Practice address
- 1659 Woodbridge LN NE
Atlanta, GA 30329-3536 - Phone
- (678) 548-1416
- NPI assigned
- Jun 5, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Administrator Registered Nurse | 163WA2000X | RN127654 | GA | Primary |
Addresses
Primary practice location
1659 Woodbridge LN NE
Atlanta, GA 30329-3536
Mailing address
1659 Woodbridge LN NE
Atlanta, GA 30329-3536
Phone (678) 548-1416
Other practice location 1
1659 Woodbrisge Lane NE
Atlanta, GA 30329
Phone (678) 548-1416
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN127654 | GA | MD | Administrator Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1336678317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1659 WOODBRIDGE LN NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303293536",
"telephone_number": "678-548-1416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1659 WOODBRIDGE LN NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303293536",
"telephone_number": "678-548-1416"
}
],
"practiceLocations": [
{
"address_1": "1659 Woodbrisge Lane NE",
"address_purpose": "LOCATION",
"city": "Atlanta",
"state": "GA",
"postal_code": "30329",
"country_code": "US",
"telephone_number": "678-548-1416",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLAKELY",
"first_name": "LISA",
"middle_name": "DOVE",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-06-05",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "163WA2000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Administrator",
"state": "GA",
"license": "RN127654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.