DR. MARY LEWIS BLACK (NPI# 1780716084) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780716084 |
| Entity Type | Individual |
| Full Name | DR. MARY LEWIS BLACK |
| Credential | MD |
| Practice Address |
1350 Walton Way Augusta GA 30901-2612 |
| Mailing Address |
1350 Walton Way Augusta GA 30901 |
| Practice Telephone | 7064142737 |
| Mailing Telephone | 7067877300 |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2018-12-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 059094 | GA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356813984 | Mary Ann Black | Registered Nurse | 1334 Dallas Ave, Winter Park, FL 32789-3641 | 2018-12-20 |
| 1679051668 | Mary Elizabeth Black | Nurse Practitioner | 222 Dave Ward Drive, Conway, AR 72032 | 2018-08-01 |
| 1750823456 | Mary Black | Case Manager/Care Coordinator | 1427 Oakland St, Saint Clair, MI 48079-5122 | 2016-11-11 |
| 1730353715 | Mary K Black | Occupational Therapist | 16 Jacobs Mill Ct, Elgin, SC 29045-8646 | 2008-04-21 |
| 1669532107 | Mary Ellen Black | Counselor | 102 East Gambier Street, Mount Vernon, OH 43050 | 2006-12-12 |
| 1407855034 | Mary M Black | Dietitian, Registered | 4300 Fayetteville Rd, Lumberton, NC 28358-2677 | 2005-07-15 |
| 1093289803 | Mary Ward Black | Psychologist | 320 Lester Hall, University, MS 38677 | 2019-01-15 |
| 1760997431 | Mary Black | Registered Nurse | 1058 College Dr, New Town, ND 58763-9112 | 2017-12-04 |
| 1417375510 | Mary E Black | Family Medicine | 825 E Rundberg Ln Ste B1, Austin, TX 78753-4860 | 2014-04-04 |
| 1710200233 | Mary Ann Black | Pharmacist | 200 W Belleview Ave, Englewood, CO 80110-6610 | 2010-03-11 |
| Street Address |
1350 WALTON WAY |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30901-2612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811993926 | Mary Jo Goolsby | Nurse Practitioner | 1350 Walton Way, Augusta, GA 30901-2612 | 2005-06-23 |
| 1750989810 | Trang Khanh Nguyen | Nurse Practitioner | 1350 Walton Way, Augusta, GA 30901-2629 | 2020-10-12 |
| 1245842152 | Margaret Anne Rossi | Registered Nurse | 1350 Walton Way, Augusta, GA 30901-2612 | 2020-08-21 |
| 1003445313 | Sarika Mishra | Registered Nurse | 1350 Walton Way, Augusta, GA 30901-2612 | 2020-04-07 |
| 1508491812 | Kyle Guderian | Nurse Practitioner | 1350 Walton Way, Augusta, GA 30901-2612 | 2020-03-06 |
| 1982246070 | Aisha Ford | Registered Nurse | 1350 Walton Way, Augusta, GA 30901-2612 | 2019-10-10 |
| 1588214977 | Alexander S Elsen | Physical Medicine & Rehabilitation | 1350 Walton Way, Augusta, GA 30901-2629 | 2019-09-17 |
| 1215599527 | Sherwin Goering | Nurse Practitioner | 1350 Walton Way, Augusta, GA 30901-2612 | 2019-07-08 |
| 1417418807 | Christopher Brandon Walker | Student in an Organized Health Care Education/Training Program | 1350 Walton Way, Augusta, GA 30901-2612 | 2019-03-27 |
| 1205309333 | Rachel Ann Shaver | Registered Nurse | 1350 Walton Way, Augusta, GA 30901-2629 | 2019-01-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477019925 | Courtney Erin Fairchild | Physician Assistant | 1101 15th Street, Pa-224, Augusta, GA 30901 | 2019-02-20 |
| 1699263921 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1022 Walton Way Spc C, Augusta, GA 30901 | 2018-04-23 |
| 1235684192 | Heather Raborn | Allergy & Immunology | 1350 Walton Way Ste 5100, Augusta, GA 30901 | 2016-08-22 |
| 1457690745 | Rehab Without Walls, Inc. | In Home Supportive Care | 820 St Sebastin Way Se, Augusta, GA 30901 | 2013-02-06 |
| 1861788051 | Christina Weidner Belcher | Physical Therapist | 1246 Pine St, Augusta, GA 30901 | 2011-06-25 |
| 1750695979 | C H Martin Company | Durable Medical Equipment & Medical Supplies | 1456 Walton Way Suite B, Augusta, GA 30901 | 2010-07-29 |
| 1366773905 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4027 Wheeler Rd, Augusta, GA 30901 | 2010-01-21 |
| 1851622484 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1715 Forest Drive, Augusta, GA 30901 | 2010-01-21 |
| 1760615280 | Absolute Family PCh | Point of Service | 2035 Old Savannah Rd., Augusta, GA 30901 | 2009-09-01 |
| 1073740643 | Ryan J Altenburg | Internal Medicine | 820 Saint Sebastian Way Ste 8a, Augusta, GA 30901 | 2009-06-22 |
| Find all providers in zip 30901 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134745953 | Molly C Shields | Pediatrics | Dugas Building Bg 107 1120 15th Street, Augusta, GA 30912-0001 | 2020-06-17 |
| 1033734918 | Lauren Wooten Smith | Pediatrics | Chog Pediatric Residency Program 1120 15th Street, Augusta, GA 30912-0001 | 2020-06-16 |
| 1487211199 | Ashley Elizabeth Miller | Pediatrics | 1146 Harper Street, Augusta, GA 30912-0001 | 2019-05-29 |
| 1952968737 | Kayla M. Lasota | Pediatrics | 11230 115th St Ae3042, Augusta, GA 30912 | 2019-05-28 |
| 1558824797 | John-david Constantine Bruce | Pediatrics | Dugas Building (bg-1071) 1120 15th Street, Augusta, GA 30912-0001 | 2019-04-12 |
| 1306229182 | Alexander James Eason | Pediatrics | Georgia Regents Medical Ctr, 1120 15th Street, Augusta, GA 30912-0001 | 2015-06-30 |
| 1184945339 | Shannon Nicole Myers | Pediatrics | 3727 Executive Center Dr, Augusta, GA 30907-2398 | 2010-06-22 |
| 1801113386 | Gerard Rubin | Pediatrics | 6 E Chestnut St Ste 310, Augusta, ME 04330-5717 | 2010-04-23 |
| 1013246487 | William Weston IIi | Pediatrics | 93 Bristlecone Ct., Augusta, GA 30909-1861 | 2009-12-15 |
| 1225285372 | Mustafa Musa Nimir | Pediatrics | 1120 15th St Ae-3042, Medical College of Georgia, Augusta, GA 30912-5000 | 2008-08-20 |
| Find all providers in AUGUSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.