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General NPI Number Information
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NPI Number | 1376767483
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Entity Type | Individual
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Provider Name | MELISSA PHILLIPS BLACK M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 1365 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-1013
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Country | US
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Telephone | 404-728-6363
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Fax | 404-728-6298
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Provider Business Mailing Address
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Address Line | 1365 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-1013
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Country | US
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Telephone | 404-728-6363
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Fax | 404-728-6298
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 056266
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License Number State | GA
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