Individual
MRS. TRACY REYMORE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8208 DEVON COURT, SUITE B, MYRTLE BEACH, SC 29572
(704) 364-6110
(704) 364-4245
Mailing address
8208 DEVON COURT, SUITE B, MYRTLE BEACH, SC 29572
(704) 364-6110
(704) 364-4245
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
101218
NC
Other
Enumeration date
02/03/2006
Last updated
12/21/2018
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