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Organization
MARY BLACK PHYSICIANS GROUP, LLC
Active
Organization
MARY BLACK PHYSICIANS GROUP, LLC
Active
Parent organization
MARY BLACK PHYSICIANS GROUP, LLC
Other names
Pediatric Associates-East
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARY BLACK PHYSICIANS GROUP, LLC
Authorized official
DEBBIE BREWER (DIRECTOR PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
1686 SKYLYN DR STE 201, SPARTANBURG, SC 29307-1079
(864) 582-8135
Mailing address
PO BOX 277827, ATLANTA, GA 30384-7827
(864) 253-8063
(864) 582-5188
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4779
—
SC
Enumeration date
12/11/2008
Last updated
12/11/2008
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