Individual
DR. KRISTIN SHANNON BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
820 W MEETING ST, LANCASTER, SC 29720-2202
(803) 285-5441
Mailing address
820 W MEETING ST, LANCASTER, SC 29720-2202
(803) 285-5441
(803) 285-7509
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22582
SC
207Q00000X
Family Medicine Physician
9901115
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891330G
—
NC
Enumeration date
06/23/2005
Last updated
09/26/2012
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