Provider Demographics
NPI:1932065679
Name:BLACKMAN, LYNETTE EUDORA
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:EUDORA
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3469 LAWRENCEVILLE HWY STE 208
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5866
Mailing Address - Country:US
Mailing Address - Phone:888-832-1550
Mailing Address - Fax:404-873-6818
Practice Address - Street 1:3469 LAWRENCEVILLE HWY STE 208
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5866
Practice Address - Country:US
Practice Address - Phone:888-832-1550
Practice Address - Fax:404-873-6818
Is Sole Proprietor?:No
Enumeration Date:2025-12-26
Last Update Date:2025-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN091417163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse