Individual
MRS. ASHLEY JEANE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 LEBSL CT, SUMMERVILLE, SC 29483-7552
(301) 305-1087
Mailing address
107 LEBSL CT, SUMMERVILLE, SC 29483-7552
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/09/2019
Last updated
08/09/2019
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