Mary Rebecca Blackington, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

43554 Issued in GA

Practice address

11525 Haynes Bridge Rd Ste 200
Alpharetta, GA 30009-4822

Phone

(770) 751-0800

Fax

(770) 751-1401

NPI assigned

Oct 2, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1194

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Roswell Pediatric Center, P.C.

  • Pediatrics Physician
  • Alpharetta, GA
  • NPI 1487772596
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1457444671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11525 HAYNES BRIDGE RD STE 200",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300094822",
            "telephone_number": "770-751-0800",
            "fax_number": "770-751-1401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11525 HAYNES BRIDGE RD STE 200",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300094822",
            "telephone_number": "770-751-0800",
            "fax_number": "770-751-1401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 C Old Milton Parkway Suite 545",
            "address_purpose": "LOCATION",
            "city": "Alpharetta",
            "state": "GA",
            "postal_code": "30005",
            "country_code": "US",
            "telephone_number": "770-751-0800",
            "fax_number": "770-751-1401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKINGTON",
        "first_name": "MARY",
        "middle_name": "REBECCA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "051424",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "43554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003134985C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yemisrach Mamo Bishaw, CSA,LSA
• Alison J Bishop, PT
• Black Swan LLC (LIV Recovery Center)
• Amber Black, LPC
• Karen K Blackburn, PT, DPT
• Marlene Louise Blaise, MD
• Heather Blakeslee
• Blancstone Psychotherapy
• Jasmine Blanks
• Paige Alexandra Blaszak

• Pediatrics Physician in Alpharetta, GA
• Providers in Alpharetta, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.