Basic Information
Provider Information
NPI: 1043614894
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARMON
FirstName: LINDSEY
MiddleName: BLOCKER
NamePrefix:  
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 221 TECHNOLOGY PKWY NW
Address2:  
City: ROME
State: GA
PostalCode: 301651369
CountryCode: US
TelephoneNumber: 7062955331
FaxNumber: 7068026151
Practice Location
Address1: 1825 MARTHA BERRY BLVD NW
Address2:  
City: ROME
State: GA
PostalCode: 301651625
CountryCode: US
TelephoneNumber: 7622352700
FaxNumber: 7062366437
Other Information
ProviderEnumerationDate: 10/22/2014
LastUpdateDate: 04/23/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XRN203458GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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