Healthcare Provider Details

I. General information

NPI: 1144770934
Provider Name (Legal Business Name): WELLMONT MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 JUDGE GRESHAM RD SUITE A
GRAY TN
37615-6213
US

IV. Provider business mailing address

105 W STONE DR SUITE 6A
KINGSPORT TN
37660-3365
US

V. Phone/Fax

Practice location:
  • Phone: 423-467-3000
  • Fax: 423-467-3019
Mailing address:
  • Phone: 423-408-7220
  • Fax: 423-408-7405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CINDY L HALLFORD
Title or Position: DIRECTOR OF PROFESSIONAL BILLING
Credential:
Phone: 423-408-7283