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General NPI Number Information
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NPI Number | 1508954975
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Entity Type | Individual
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Provider Name | JEFFERY REUBEN BLACK MD
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 109 PHYSICIANS DR STE B
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City | GREER
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State | SC
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Zip | 29650-2446
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Country | US
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Telephone | 864-797-9170
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Fax | 864-797-9175
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-522-8603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 37486
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 89089
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License Number State | SC
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