Organization
MARY BLACK PHYSICIANS GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA L MATTSON (SENIOR CREDENTIALING COORDINATOR)
(214) 473-7043
Entity
Organization
Contact information
Practice address
500 SQUIRES PT, SUITE A, DUNCAN, SC 29334-8867
(864) 433-8980
Mailing address
PO BOX 277827, ATLANTA, GA 30384-7827
(864) 253-8080
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/24/2007
Last updated
07/02/2008
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