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General NPI Number Information
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NPI Number | 1669554630
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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 | 10/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 702 S ALABAMA AVE
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City | CHESNEE
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State | SC
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Zip | 29323-1706
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Country | US
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Telephone | 864-703-1414
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Fax | 864-703-1419
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Provider Business Mailing Address
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Address Line | 702 S ALABAMA AVE
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City | CHESNEE
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State | SC
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Zip | 29323-1706
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Country | US
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Telephone | 864-703-1414
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Fax | 864-703-1419
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Authorized Official
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Title or Position | VP
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Name | V KAREN FLINN
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Credential |
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Telephone | 214-473-3773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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