Healthcare Provider Details

I. General information

NPI: 1902243686
Provider Name (Legal Business Name): FRYECARE WATAUGA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 WINKLERS CREEK RD STE C
BOONE NC
28607-7838
US

IV. Provider business mailing address

245 WINKLERS CREEK RD STE C
BOONE NC
28607-7838
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-1800
  • Fax: 828-262-5444
Mailing address:
  • Phone: 828-262-1800
  • Fax: 828-262-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WESLEY O. JAMES
Title or Position: REGIONAL CFO, TENET
Credential:
Phone: 404-265-5009