Individual
ALEXANDRIA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 E WOOD ST STE 401, SPARTANBURG, SC 29303-3040
(864) 560-6654
(864) 560-7353
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
22567
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP6039
—
SC
01
—
SCF6025019
MEDICARE PIN
SC
01
—
SCF6029068
MEDICARE PIN
SC
01
—
SCF602J577
MEDICARE PIN
SC
Enumeration date
05/20/2019
Last updated
02/14/2022
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