IVY BLACK

POWDER SPRINGS, GA
NPI1104571462
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner Family
(Licence: GA  RN195496)
Enumeration Date2022-02-15
Last Update Date2022-02-15
Business Address
IVY BLACK C-NP
4250 BROWNSVILLE RD
POWDER SPRINGS, GA 30127-2559
Phone number: 678-567-8000
Mailing Address
IVY BLACK C-NP
4467 WORTHINGS CT
POWDER SPRINGS, GA 30127-1471
Phone number: 706-405-1195
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