Individual
KATHERINE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1062 FORSYTH ST STE 2E, MACON, GA 31201-8631
(478) 633-7330
(478) 633-7360
Mailing address
1062 FORSYTH ST STE 2E, MACON, GA 31201-8631
(478) 633-7330
(478) 633-7360
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
59619
TN
208000000X
Pediatrics Physician
92412
GA
2080P0206X
Pediatric Gastroenterology Physician
Primary
92412
GA
Other
Enumeration date
03/22/2016
Last updated
03/29/2024
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