Healthcare Provider Details

I. General information

NPI: 1811030760
Provider Name (Legal Business Name): MARY BLACK HEALTH SYSTEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1686 SKYLYN DR STE 201
SPARTANBURG SC
29307-1058
US

IV. Provider business mailing address

PO BOX 406757
ATLANTA GA
30384-6757
US

V. Phone/Fax

Practice location:
  • Phone: 864-585-3456
  • Fax:
Mailing address:
  • Phone: 864-585-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA HURLEY
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 214-473-3993