Organization
MARY BLACK HEALTH SYSTEM LLC
Active
Parent organization
MARY BLACK HEALTH SYSTEM LLC
Other names
Peachview Medical Park
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARY BLACK HEALTH SYSTEM LLC
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7000
Entity
Organization
Contact information
Practice address
722 HYATT ST, GAFFNEY, SC 29341-2643
(864) 488-1400
Mailing address
PO BOX 406757, ATLANTA, GA 30384-6757
(864) 253-8080
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP2805
—
SC
Enumeration date
07/23/2006
Last updated
06/25/2008
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