# GIM BARRY BLACKSTON, MD, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689193237
- **Authorized official:** DR. BARRY C BLACKSTON MD (DIRECTOR)
- **Authorized official phone:** (864) 242-5678

## Contact information

- **Practice address:** 8 MEMORIAL MEDICAL CT STE 4, GREENVILLE, SC 29605-4400
- **Practice address phone:** (864) 242-5678
- **Practice address fax:** (864) 242-5679
- **Mailing address:** 8 MEMORIAL MEDICAL CT STE 4, GREENVILLE, SC 29605-4400
- **Mailing address phone:** (864) 242-5678
- **Mailing address fax:** (864) 242-5679

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 16698 | SC | Yes |

## Other

- **Enumeration date:** 09/14/2017
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1316948185 | NPPES | — |