Individual
WILEY S BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2626 PARKER TRL, GAINESVILLE, GA 30506-1800
(770) 532-8608
(770) 718-1964
Mailing address
2626 PARKER TRL, GAINESVILLE, GA 30506-1800
(770) 532-8608
(770) 718-1964
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
009767
GA
Other
Enumeration date
01/24/2008
Last updated
01/24/2008
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