| Mary Black Physicians Group, Llc | |
|
5470 N Main St Cowpens SC 29330-9705 | |
| (864) 463-3286 | |
| Not Available |
| Full Name | Mary Black Physicians Group, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5470 N Main St, Cowpens, South Carolina |
| Authorized Official Name and Position | Debbie Brewer (DIRECTOR PROVIDER ENROLLMENT) |
| Authorized Official Contact | 6154657626 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Black Physicians Group, Llc Po Box 277827 Atlanta GA 30384-7827 Ph: (864) 253-8080 | Mary Black Physicians Group, Llc 5470 N Main St Cowpens SC 29330-9705 Ph: (864) 463-3286 |
| NPI Number | 1396980876 |
|---|---|
| Provider Enumeration Date | 12/11/2008 |
| Last Update Date | 12/11/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396980876 | NPI | - | NPPES |
| GP4783 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Mary Black Health System Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5470 N Main St, Cowpens, SC 29330 Phone: 864-463-3286 |