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General NPI Number Information
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NPI Number | 1588866198
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Entity Type | Organization
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Legal Business Name | JUDSON G BLACK MD LLC
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 980 JOHNSON FERRY RD NE SUITE 510
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City | ATLANTA
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State | GA
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Zip | 30342-1626
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Country | US
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Telephone | 404-303-9945
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Fax |
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Provider Business Mailing Address
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Address Line | 908 JOHNSON FERRY ROAD SUITE 510
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City | ATLANTA
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State | GA
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Zip | 30342-1626
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Country | US
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Telephone | 404-303-9945
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUDSON G BLACK
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Credential | MD
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Telephone | 404-303-9945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 017131
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License Number State | GA
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