Mona Blackwell, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN262650 Issued in GA

Practice address

4850 Sugarloaf Pkwy Ste 101
Lawrenceville, GA 30044-2860

Phone

(678) 490-8300

NPI assigned

Oct 11, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: mona.blackwell.1@27127.direct.athenahealth.com

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

{
    "created_epoch": "1633910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633910400000",
    "number": "1811659535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4850 SUGARLOAF PKWY STE 101",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300442860",
            "telephone_number": "678-490-8300",
            "fax_number": "844-772-7366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4850 SUGARLOAF PKWY STE 101",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300442860",
            "telephone_number": "678-490-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "MONA",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-11",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN262650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert E Black III, MD
• Charlotte H Blackburn, CRNA
• Jessica Blackburn
• Jordon Blackmon, PA-C
• Carlisha Blackwell
• Mary Blaesing
• Ghazal Blair, PHARMD
• Mark Blair
• Opal Mullings Blake, NP-C
• Maribel Blanco, R.N.

• Family Nurse Practitioner in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.