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General NPI Number Information
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NPI Number | 1700149648
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Entity Type | Individual
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Provider Name | GARY CHASE BLACK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 06/01/2018
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Provider Practice Location Address
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Address Line | 9400 RHEA COUNTY HWY
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City | DAYTON
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State | TN
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Zip | 37321
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Country | US
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Telephone | 423-285-5220
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Fax | 423-285-5506
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Provider Business Mailing Address
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Address Line | 167 ASHLEY AVE SUITE 301, MSC 912
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City | CHARLESTON
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State | SC
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Zip | 29425-9120
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Country | US
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Telephone | 843-792-0192
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Fax | 843-792-9314
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | LL34886
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 55829
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License Number State | TN
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