Individual
CONNIE J BLACKSTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
404 SE MAIN STREET, SUITE 300, SIMPSONVILLE, SC 29681-0279
(864) 963-8002
(864) 963-2742
Mailing address
PO BOX 279, 404 SE MAIN STREET, SIMPSONVILLE, SC 29681-0279
(864) 963-8002
(864) 963-2742
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15537
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155370
—
SC
01
—
576007863095
BCBS
SC
Enumeration date
08/11/2006
Last updated
02/19/2015
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