Individual
JENNIFER BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
989 LAWRENCEVILLE HWY, LAWRENCEVILLE, GA 30046-4702
(770) 962-1616
Mailing address
3024 ABBOTTS OAK WAY, DULUTH, GA 30097-2190
(770) 547-5889
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN236581
GA
Other
Enumeration date
03/15/2021
Last updated
03/15/2021
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