| James Durward Black Jr, MD | |
|
300 Courtyard Dr., Suite B, Cartersville, GA 30120-8535 | |
| (770) 386-1076 | |
| (770) 606-0452 |
| Full Name | James Durward Black Jr |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Experience | 44 Years |
| Location | 300 Courtyard Dr., Cartersville, Georgia |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942304423 | NPI | - | NPPES |
| 581660430 | Other | GA | TAX ID |
| 000320889B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | 28379 (Georgia) | Secondary |
| 208800000X | Urology | 036.164834 (Illinois) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Methodist Medical Center Of Illinois | Peoria, IL | Hospital |
| Proctor Hospital | Peoria, IL | Hospital |
| Pekin Memorial Hospital | Pekin, IL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Methodist Medical Center Of Illinois | 1355259714 | 283 |
| Entity Name | Methodist Medical Center Of Illinois |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1982656575 PECOS PAC ID: 1355259714 Enrollment ID: O20031126000494 |
| Mailing Address | Practice Location Address |
|---|---|
| James Durward Black Jr, MD Po Box 200006, Cartersville, GA 30120-9001 Ph: (770) 386-1076 | James Durward Black Jr, MD 300 Courtyard Dr., Suite B, Cartersville, GA 30120-8535 Ph: (770) 386-1076 |
Anuj Sunil Desai, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 970 Joe Frank Harris Pkwy Se Ste 260, Cartersville, GA 30120 Phone: 770-607-1893 | |
Jeffrey G Proctor, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 970 Joe Frank Harris Pkwy Se, Suite 260, Cartersville, GA 30120 Phone: 770-607-1893 Fax: 770-607-2930 |