Individual
STEVEN EDWARD BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 W ACADEMY STREET, GAINESVILLE, GA 30501
(770) 282-8820
Mailing address
PO BOX 2417, GAINESVILLE, GA 30503-2417
(770) 532-9936
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
045727
GA
2085R0204X
Vascular & Interventional Radiology Physician
045727
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000798971G
—
GA
05
—
000798971K
—
GA
01
—
581177261A
MEDICARE GRP PROV #
GA
01
—
P00332154
RAILROAD MEDICARE
GA
Enumeration date
07/06/2006
Last updated
02/03/2026
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