Provider Demographics
NPI:1366082539
Name:BILLING BLACK, GABRIELLE A (AG-ACNP)
Entity type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:A
Last Name:BILLING BLACK
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:MISS
Other - First Name:GABRIELLE
Other - Middle Name:A
Other - Last Name:BILLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1468 BRIARWOOD RD NE UNIT 909
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-5740
Mailing Address - Country:US
Mailing Address - Phone:770-310-0666
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE FL 3
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2212
Practice Address - Country:US
Practice Address - Phone:404-686-7858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213805163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse