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Organization
MARY BLACK PHYSICIANS GROUP LLC
Active
Organization
MARY BLACK PHYSICIANS GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOPHIA L ARWOOD (DIRECTOR)
(615) 628-6038
Entity
Organization
Contact information
Practice address
130 DILLON DR, SPARTANBURG, SC 29307-1018
(864) 585-2027
(864) 585-2488
Mailing address
PO BOX 689022, PROVIDER ENROLLMENT DEPARTMENT, FRANKLIN, TN 37068-9022
(615) 465-7000
(615) 465-3007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
2086S0105X
Surgery of the Hand (Surgery) Physician
—
—
208800000X
Urology Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4690
—
SC
Enumeration date
10/10/2006
Last updated
01/22/2014
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