Active NPI
Audria Kaye Black, MD
- Psychiatry Physician
- Cordova, TN
National Provider Identifier
1639295272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 36627
- Practice address
- 8000 Centerview Parkway
Ste 104
Cordova, TN 38018 - Phone
- (901) 755-6280
- Fax
- (901) 755-7897
- NPI assigned
- Mar 22, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 36627 | TN | Primary |
Addresses
Primary practice location
8000 Centerview Parkway
Ste 104
Cordova, TN 38018
Mailing address
PO Box 38175
Germantown, TN 38183
Phone (901) 755-6280
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TN36627 | Other | TN | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36627 | TN | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Black Holdings Group,LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Adolescent and Children Mental Health Clinic/Center
- Cordova, TN
- NPI 1568861037
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1639295272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 38175",
"city": "GERMANTOWN",
"state": "TN",
"postal_code": "38183",
"telephone_number": "901-755-6280",
"fax_number": "901-755-7897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8000 CENTERVIEW PARKWAY",
"address_2": "STE 104",
"city": "CORDOVA",
"state": "TN",
"postal_code": "38018",
"telephone_number": "901-755-6280",
"fax_number": "901-755-7897"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "AUDRIA",
"middle_name": "KAYE",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-22",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TN",
"license": "36627",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "TN36627",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cordova, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.