| Mary Black Physicians Group, Llc | |
|
2995 Reidville Rd Suite 260 Spartanburg SC 29301-5628 | |
| (864) 574-2866 | |
| Not Available |
| Full Name | Mary Black Physicians Group, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2995 Reidville Rd, Spartanburg, 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) 253-8063 | Mary Black Physicians Group, Llc 2995 Reidville Rd Suite 260 Spartanburg SC 29301-5628 Ph: (864) 574-2866 |
| NPI Number | 1306081880 |
|---|---|
| Provider Enumeration Date | 12/11/2008 |
| Last Update Date | 12/11/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306081880 | NPI | - | NPPES |
| GP4776 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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