James Durward Black Jr, MD | |
300 Courtyard Dr., Suite B, Cartersville, GA 30120-8535 | |
(770) 386-1076 | |
(770) 606-0452 |
Full Name | James Durward Black Jr |
---|---|
Gender | Male |
Speciality | Urology |
Experience | 44 Years |
Location | 300 Courtyard Dr., Cartersville, Georgia |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1942304423 | NPI | - | NPPES |
581660430 | Other | GA | TAX ID |
000320889B | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208800000X | Urology | 28379 (Georgia) | Secondary |
208800000X | Urology | 036.164834 (Illinois) | Primary |
Facility Name | Location | Facility Type |
---|---|---|
Methodist Medical Center Of Illinois | Peoria, IL | Hospital |
Pekin Memorial Hospital | Pekin, IL | Hospital |
Proctor Hospital | Peoria, IL | Hospital |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Methodist Medical Center Of Illinois | 1355259714 | 246 |
Entity Name | Methodist Medical Center Of Illinois |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1982656575 PECOS PAC ID: 1355259714 Enrollment ID: O20031126000494 |
Mailing Address | Practice Location Address |
---|---|
James Durward Black Jr, MD Po Box 200006, Cartersville, GA 30120-9001 Ph: (770) 386-1076 | James Durward Black Jr, MD 300 Courtyard Dr., Suite B, Cartersville, GA 30120-8535 Ph: (770) 386-1076 |
Anuj Sunil Desai, M.D. Urology Medicare: Medicare Enrolled Practice Location: 970 Joe Frank Harris Pkwy Se Ste 260, Cartersville, GA 30120 Phone: 770-607-1893 | |
Jeffrey G Proctor, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 970 Joe Frank Harris Pkwy Se, Suite 260, Cartersville, GA 30120 Phone: 770-607-1893 Fax: 770-607-2930 |