Organization
MARY BLACK PHYSICIANS GROUP, LLC
Active
Parent organization
MARY BLACK PHYSICIANS GROUP, LLC
Other names
Family Physicians of Spartanburg
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
1250 JOHN B WHITE SR BLVD, SPARTANBURG, SC 29306-3929
(864) 576-9201
Mailing address
PO BOX 277827, ATLANTA, GA 30384-7827
(864) 253-8080
(864) 582-5188
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4767
—
SC
Enumeration date
12/11/2008
Last updated
12/11/2008
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