Organization
MARY BLACK PHYSICIANS GROUP, LLC
Active
Parent organization
MARY BLACK PHYSICIANS GROUP, LLC
Other names
Piedmont Internal Medicine-Westside
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
2995 REIDVILLE RD, SUITE 210, SPARTANBURG, SC 29301-5628
(864) 596-7424
Mailing address
PO BOX 277827, ATLANTA, GA 30384-7827
(864) 253-8080
(864) 582-5188
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4764
—
SC
Enumeration date
12/11/2008
Last updated
12/11/2008
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