Individual
DR. ROBERT E BLACK III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-0000
(770) 277-3056
(855) 204-5244
Mailing address
PO BOX 551420, FORT LAUDERDALE, FL 33355-1420
(800) 243-3839
(954) 839-2569
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
067920
GA
207L00000X
Anesthesiology Physician
67920
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003126898A
—
GA
Enumeration date
07/12/2007
Last updated
04/02/2014
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