Individual
DR. RUSSELL STEVEN BLACKWELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D. , M.DIV.
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34724
SC
207Q00000X
Family Medicine Physician
LL34724
SC
Other
Enumeration date
06/13/2012
Last updated
06/22/2015
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