Wiley S Black, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

009767 Issued in GA

Practice address

2626 Parker TRL
Gainesville, GA 30506-1800

Phone

(770) 532-8608

Fax

(770) 718-1964

NPI assigned

Jan 24, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northeast Georgia Physicians Group Inc

  • Family Medicine Physician
  • Gainesville, GA
  • NPI 1891745212

  Surgery

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201132800000",
    "number": "1386821007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2626 PARKER TRL",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305061800",
            "telephone_number": "770-532-8608",
            "fax_number": "770-718-1964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2626 PARKER TRL",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305061800",
            "telephone_number": "770-532-8608",
            "fax_number": "770-718-1964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "WILEY",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-24",
        "last_updated": "2008-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "009767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl Lynn Bittel, APRN
• Jeffry Joseph Bizon, MD
• Emily Anne Black, MD
• Steven Edward Black, M.D.
• Tina Marie Black
• Black's Pediatric Therapy, Inc.
• Julianne Blackburn, PA
• Brianna Blackwell
• Kristen H Blair, AGACNP
• Shirley Blake, RNC

• Surgery Physician in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.