Individual
CASEY R. BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
125 EAGLE SPRING DR, STOCKBRIDGE, GA 30281-6328
(770) 213-3366
(404) 962-6943
Mailing address
125 EAGLE SPRING DR, STOCKBRIDGE, GA 30281-6328
(770) 213-3366
(404) 962-6943
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN146749
GA
Other
Enumeration date
12/03/2012
Last updated
05/10/2017
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