Individual
JAMES DURWARD BLACK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 COURTYARD DR., SUITE B, CARTERSVILLE, GA 30120-8535
(770) 386-1076
(770) 606-0452
Mailing address
PO BOX 200006, CARTERSVILLE, GA 30120-9001
(770) 386-1076
(770) 606-0452
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036.164834
IL
208800000X
Urology Physician
28379
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000320889B
—
GA
01
—
581660430
TAX ID
GA
Enumeration date
09/12/2006
Last updated
02/20/2024
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