Black, Tina Marie

Black, Tina Marie is an individual health care provider with primary practice located at 4502 Summer Gate Ct , Gainesville GA 30506-4677. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics, which is considered as her primary health care specialty. Black, Tina Marie can be contacted via phone (770) 378-5986.

Contact Information

Primary practice address
4502 Summer Gate Ct Gainesville GA 30506-4677
Phone: (770) 378-5986
Fax: (770) 536-0346
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics 225XP0200X OT003199 Georgia

Profile Details

NPI number 1013087428
LBN Legal business name Black, Tina Marie
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 9th, 2006
Last updated Jul 9th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1013087428 NPPES
Georgia Other 307327 WELLCARE
Georgia Other 10038361 WELLCARE

Popular Providers