Healthcare Provider Details

I. General information

NPI: 1053730838
Provider Name (Legal Business Name): EMILY D. BLACK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 EDGEWOOD DR
GREENVILLE SC
29605-4246
US

IV. Provider business mailing address

101 GREGOR MENDEL CIR
GREENWOOD SC
29646-2316
US

V. Phone/Fax

Practice location:
  • Phone: 864-250-7944
  • Fax: 864-250-9582
Mailing address:
  • Phone: 864-388-1072
  • Fax: 864-388-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number77950
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: