MEDICARE: MARGAUX BLACK GRAY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	94984	GA

General Provider Information

NPI Number	:	1235592577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGAUX BLACK GRAY MD

Provider Business Mailing Address
First Line	:	5883 GLENRIDGE DR STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5694
Country	:	US
Telephone Number	:	404-303-1314
Fax Number	:

Provider Business Practice Location Address
First Line	:	5883 GLENRIDGE DR STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5694
Country	:	US
Telephone Number	:	404-303-1314
Fax Number	:	404-303-1399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2016
Last Update Date	:	08/04/2023

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Directions to “ MARGAUX BLACK GRAY MD” Practice Location

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