| Black Holdings Group,llc | |
|
8000 Centerview Pkwy Suite 104 Cordova TN 38018-4227 | |
| (901) 755-6280 | |
| (901) 755-7897 |
| Full Name | Black Holdings Group,llc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 8000 Centerview Pkwy, Cordova, Tennessee |
| Authorized Official Name and Position | Audria Kaye Black (PHYSICIAN) |
| Authorized Official Contact | 9017556280 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Holdings Group,llc Po Box 38175 Germantown TN 38183-0175 Ph: (901) 755-6280 | Black Holdings Group,llc 8000 Centerview Pkwy Suite 104 Cordova TN 38018-4227 Ph: (901) 755-6280 |
| NPI Number | 1568861037 |
|---|---|
| Provider Enumeration Date | 08/20/2014 |
| Last Update Date | 08/20/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568861037 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 36627 (Tennessee) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 36627 (Tennessee) | Primary |
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