Healthcare Provider Details

I. General information

NPI: 1760104392
Provider Name (Legal Business Name): APPALACHIAN HIGHLANDS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 WILLS PRIVATE DR
CHURCH HILL TN
37642-2800
US

IV. Provider business mailing address

196 WILLS PRIVATE DR
CHURCH HILL TN
37642-2800
US

V. Phone/Fax

Practice location:
  • Phone: 423-782-9266
  • Fax: 423-616-9753
Mailing address:
  • Phone: 423-782-9266
  • Fax: 423-616-9753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: BRYAN D CARTER
Title or Position: OWNER
Credential:
Phone: 423-782-9266