Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Nicole Black, PA-C

Individual provider Physician Assistant · NPI 1043874910

Nicole Black, PA-C is a Physician Assistant in Marietta, Georgia. Qualified in 2020, 6 years ago. Practices with Marietta Dermatology Associates PA, a 22-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
6
Licensed in
GA
In the registry since
2019
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

111 Marble Mill Rd NW
Marietta, GA 30060-1047
Phone: (770) 422-1013
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 9841 (GA)

Record details

NPI number1043874910
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedApril 26, 2019
Last updated in NPPESAugust 8, 2024
Certification dateAugust 8, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Marietta Dermatology Associates Pa — 22 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Marietta