Provider Demographics
NPI:1992932842
Name:BLACK, ERIN G (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:G
Last Name:BLACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:939 EMERALD AVE
Mailing Address - Street 2:SUITE 805
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4502
Mailing Address - Country:US
Mailing Address - Phone:865-647-3380
Mailing Address - Fax:865-647-3389
Practice Address - Street 1:939 EMERALD AVE
Practice Address - Street 2:SUITE 805
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4502
Practice Address - Country:US
Practice Address - Phone:865-647-3380
Practice Address - Fax:865-647-3389
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TNMD49772207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program