Blackstone, Connie J

Blackstone, Connie J is an individual health care provider with primary practice located at 404 Se Main Street Suite 300, Simpsonville SC 29681-0279. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Blackstone, Connie J can be contacted via phone (864) 963-8002.

Contact Information

Primary practice address
404 Se Main Street Suite 300 Simpsonville SC 29681-0279
Phone: (864) 963-8002
Fax: (864) 963-2742
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 15537 South Carolina

Profile Details

NPI number 1497766588
LBN Legal business name Blackstone, Connie J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 11th, 2006
Last updated Feb 19th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497766588 NPPES
South Carolina MEDICAID 155370
South Carolina Other 576007863095

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