Provider Demographics
NPI:1629184403
Name:BLACK, LAURA ANN
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:BLACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:BROWN
Other - Last Name:CURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7421 CARMEL EXECUTIVE PARK DR STE 320
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8405
Mailing Address - Country:US
Mailing Address - Phone:704-543-9692
Mailing Address - Fax:704-543-8547
Practice Address - Street 1:7421 CARMEL EXECUTIVE PARK DR STE 320
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8405
Practice Address - Country:US
Practice Address - Phone:704-543-9692
Practice Address - Fax:704-543-8547
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine