NPIMap

Individual provider Active NPI

Nicole Marie Blackburn, M.D.

  • Obstetrics & Gynecology Physician
  • Atlanta, GA
National Provider Identifier
1689963951
Registry record updated Sep 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
73617 Issued in GA
Practice address
5780 Peachtree Dunwoody Rd Ste 320
Atlanta, GA 30342-1575
Phone
(404) 256-2943
Fax
(404) 256-6073
NPI assigned
Apr 7, 2011
Last updated
Sep 29, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 73617 GA Primary

Addresses

Primary practice location

5780 Peachtree Dunwoody Rd Ste 320
Atlanta, GA 30342-1575

Mailing address

5780 Peachtree Dunwoody Rd
Suite 320
Atlanta, GA 30342-1554
Phone (404) 256-2943

Other names 1

  • Dr. Nicole Pasteur Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Aug 27, 2015 through Aug 27, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
73617GAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Atlanta Women's Health Group, P.C. Obstetrics & Gynecology PastSince Oct 4, 2020 Accepting new patients
Northside Northpoint OB GYN 2 LLC Obstetrics & Gynecology Past Accepting new patients
Northside Hospital, Inc. Past Accepting new patients
Atlanta Women's Health Group, P.C. PastSince Oct 4, 2020 Accepting new patients
Peachtree Women's Clinic 2 LLC Obstetrics & Gynecology Past Accepting new patients
Northside Hospital, Inc. Past Accepting new patients
Atlanta Women's Health Group, P.C. Obstetrics & Gynecology Past Accepting new patients

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1302134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1689963951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5780 PEACHTREE DUNWOODY RD",
            "address_2": "SUITE 320",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421554",
            "telephone_number": "404-256-2943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5780 PEACHTREE DUNWOODY RD STE 320",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421575",
            "telephone_number": "404-256-2943",
            "fax_number": "404-256-6073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-07",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "73617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "PASTEUR",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.