Organization
MARY BLACK PHYSICIANS GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE BREWER (DIRECTOR, PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
391 GLENN SPRINGS RD, PACOLET, SC 29372-2417
(864) 474-3013
Mailing address
PO BOX 277827, ATLANTA, GA 30384-7827
(864) 474-3013
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/24/2007
Last updated
06/12/2009
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