Individual
GARRETT BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
905C S FRONTAGE RD, MERIDIAN, MS 39301-6113
(601) 482-4955
Mailing address
905C S FRONTAGE RD, MERIDIAN, MS 39301-6113
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
BLAC-CVY41K
MS
Other
Enumeration date
05/12/2025
Last updated
05/12/2025
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