IVY BLACK

KENNESAW, GA
NPI1104571462
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: GA  RN195496)
Enumeration Date2022-02-15
Last Update Date2025-06-12
Business Address
IVY BLACK C-NP
2782 COBB PKWY NW
KENNESAW, GA 30152-3472
Phone number: 706-405-1195
Mailing Address
IVY BLACK C-NP
2782 COBB PKWY NW
KENNESAW, GA 30152-3472
Phone number: 706-405-1195
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