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General NPI Number Information
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NPI Number | 1073323994
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Entity Type | Individual
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Provider Name | GERRI MONIQUE BLACK PA
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Gender | Female
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 721 GLENWOOD DR STE 560
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City | CHATTANOOGA
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State | TN
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Zip | 37404-1129
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Country | US
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Telephone | 423-622-2494
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Fax |
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Provider Business Mailing Address
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Address Line | 2302 S MERIDIAN ST # B
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City | INDIANAPOLIS
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State | IN
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Zip | 46225-2022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 1229443
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License Number State | TN
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