Individual
JONATHAN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 RICHLAND MEDICAL PARK DR, SUITE 200, COLUMBIA, SC 29203-6834
(803) 765-9233
(803) 779-0344
Mailing address
1 RICHLAND MEDICAL PARK DR, SUITE 200, COLUMBIA, SC 29203-6834
(803) 765-9233
(803) 779-0344
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
TL34783
SC
Other
Enumeration date
05/16/2007
Last updated
07/19/2012
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