Individual
DR. JOHN WILLIAM BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3623 LATROBE DR, SUITE 216, CHARLOTTE, NC 28211
(704) 332-1291
(704) 332-5206
Mailing address
PO BOX 221249, CHARLOTTE, NC 28222-1249
(704) 332-1291
(704) 332-5206
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
27821
SC
2085R0202X
Diagnostic Radiology Physician
Primary
96-01000
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891010R
—
NC
Enumeration date
12/02/2005
Last updated
09/13/2020
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