Healthcare Provider Details

I. General information

NPI: 1881687689
Provider Name (Legal Business Name): BLUE RIDGE RADIOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 STEVENSWOOD DR
BRISTOL TN
37620-7308
US

IV. Provider business mailing address

111 STEVENSWOOD DR
BRISTOL TN
37620-7308
US

V. Phone/Fax

Practice location:
  • Phone: 423-968-1144
  • Fax: 423-968-3453
Mailing address:
  • Phone: 423-968-1144
  • Fax: 423-968-3453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE SNYDER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 423-301-6567