Individual
DR. DEREK ALAN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1211 BALD RIDGE MARINA RD, CUMMING, GA 30041-8484
(470) 239-6625
(470) 239-6626
Mailing address
1211 BALD RIDGE MARINA RD, CUMMING, GA 30041-8484
(470) 239-6625
(470) 239-6626
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT002922
GA
Other
Enumeration date
09/20/2013
Last updated
10/26/2020
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