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General NPI Number Information
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NPI Number | 1295823045
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Entity Type | Organization
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Legal Business Name | MARY BLACK PHYSICIANS GROUP LLC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 130 DILLON DR
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City | SPARTANBURG
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State | SC
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Zip | 29307-1018
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Country | US
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Telephone | 864-585-2027
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Fax | 864-585-2488
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Provider Business Mailing Address
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Address Line | PO BOX 689022 PROVIDER ENROLLMENT DEPARTMENT
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone | 615-465-7000
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Fax | 615-465-3007
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Authorized Official
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Title or Position | DIRECTOR
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Name | SOPHIA L ARWOOD
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Credential |
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Telephone | 615-628-6038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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Taxonomy #10
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number |
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Taxonomy #11
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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Taxonomy #13
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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