Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 77950 | GA |
NPI | 1053730838 |
---|---|
Provider Name | Emily Black |
First Address | Atlanta, GA 30322-1013 |
Second Address | Atlanta, GA 30322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2014 |
Last Update Date | 12/10/2020 |