Individual
GARY CHASE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9400 RHEA COUNTY HWY, DAYTON, TN 37321
(423) 285-5220
(423) 285-5506
Mailing address
167 ASHLEY AVE, SUITE 301, MSC 912, CHARLESTON, SC 29425-9120
(843) 792-0192
(843) 792-9314
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
LL34886
SC
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
55829
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q029957
—
TN
01
—
T00148A
MEDICARE PTAN
TN
Enumeration date
06/15/2012
Last updated
06/01/2018
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