IndividualActive
Black Peterson, CNIM
NPI 1447833173 · Clinical Neurophysiology Physician · West Columbia, SC
Provider details
- NPI number
- 1447833173
- Entity type
- Individual
- Primary specialty
- Clinical Neurophysiology PhysicianAllopathic & Osteopathic Physicians
- Credential
- CNIM
- Sex
- Male
- Sole proprietor
- No
- License
- 4700 (SC)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1304 Sunset Blvd # 203
West Columbia, SC 29169-5914
Phone: (888) 851-3677
Approximate (ZIP-level) locationGet directions
Mailing address
1304 Sunset Blvd # 203
West Columbia, SC 29169-5914
Registry dates
- Enumerated
- 2021-04-30
- Last updated
- 2021-04-30
- Certified
- 2021-04-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.