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NPI Lookup from the NPI Registry — National Provider Identifier Database

Contact Information

ROBERT E BLACK III, MD
1000 MEDICAL CENTER BLVD
LAWRENCEVILLE, GA30046-0000
 Phone: 770-277-3056
 Fax: 855-204-5244
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anesthesiology

207L00000X 79 Physician/Addiction Medicine
Indicates primary specialty

NPI Profile & details for ROBERT E BLACK III · (Male)

NPI # 1003015728
Status Active
Credentials MD
Entity Individual
Enumeration date 07/12/2007
Last updated 04/02/2014 - About 5 years ago
Sole proprietor 1 Yes
Identifiers
  • GA License # 067920
  • GA License # 67920
  • GA Medicaid 003126898A
Hospital affiliation(s)
  • GWINNETT MEDICAL CENTER - (Acute Care)
    1000 MEDICAL CENTER BOULEVARD
    LAWRENCEVILLE, GA 30045
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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