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NPI Code Detail

MEDICARE: MR. GEORGE EDWARD BLACK IV MD

MEDICARE: MR. GEORGE EDWARD BLACK IV 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
12086S0102XSurgical Critical Care Physician258376NC
22086S0127XTrauma Surgery Physician258376NC
3208600000XSurgery Physician258376NC

General Provider Information

NPI Number : 1538431994
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GEORGE EDWARD BLACK IV MD
Provider Business Mailing Address
First Line : 1000 BLYTHE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-5871
Country : US
Telephone Number : 704-355-2000
Fax Number :
Provider Business Practice Location Address
First Line : 1000 BLYTHE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-5871
Country : US
Telephone Number : 704-355-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2012
Last Update Date : 08/08/2025

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