Individual
JOHN B BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2615
(770) 991-8000
Mailing address
PO BOX 100041, KENNESAW, GA 30156-9241
(770) 779-2178
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
031702
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000400573
—
GA
Enumeration date
12/28/2005
Last updated
07/18/2012
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