Organization
MARY BLACK PHYSICIANS GROUP, LLC
Active
Parent organization
MARY BLACK PHYSICIANS GROUP, LLC
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
1700 SKYLYN DR, SPARTANBURG, SC 29307-1041
(864) 253-8080
(864) 582-5188
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
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Enumeration date
12/11/2008
Last updated
12/11/2008
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