Individual
MR. TREVOR ELAN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
20 GLENLAKE PKWY, KAISER PERMANENTE GLENLAKE MEDICAL CENTER, ATLANTA, GA 30328-3473
(818) 326-1058
Mailing address
3495 PIEDMONT RD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305-1717
(404) 504-5678
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD001289
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/15/2013
Last updated
01/10/2022
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