Individual
MICHAEL ANTHONY BLACK SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
1762 E MAIN ST, SPARTANBURG, SC 29307-2231
(864) 591-2261
Mailing address
PO BOX 749306, ATLANTA, GA 30374-9306
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3808
SC
363A00000X
Physician Assistant
PA10004010
WA
Other
Enumeration date
08/05/2007
Last updated
10/31/2024
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