Individual
PRINCESS BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5297 KINGSBERRY ST, COLUMBUS, GA 31907-4234
(706) 905-1060
Mailing address
5297 KINGSBERRY ST, COLUMBUS, GA 31907-4234
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
06/11/2026
Last updated
06/11/2026
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