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Contact Information

TINA M BLACK
4502 SUMMER GATE CT
GAINESVILLE, GA30506-4677
 Phone: 770-378-5986
 Fax: 770-536-0346
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

225XP0200X 67 Occupational Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for TINA M BLACK · (Female)

NPI Number 1013087428
Status Active
Credentials
Entity Individual
Enumeration date 11/09/2006
Last updated 07/09/2007 - About 12 years ago
Sole proprietor 1 No
Identifiers
  • GA License # OT003199
  • GA Other 10038361 AMERIGROUP
  • GA Other 307327 WELLCARE
Hospital affiliation(s) Not Available
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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