Healthcare Provider Details

I. General information

NPI: 1982929170
Provider Name (Legal Business Name): HIGHLANDS PODIATRY, P.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 FALLS DR NW
ABINGDON VA
24210-8093
US

IV. Provider business mailing address

2765 W STATE ST
BRISTOL TN
37620-1828
US

V. Phone/Fax

Practice location:
  • Phone: 423-764-2299
  • Fax: 423-968-3340
Mailing address:
  • Phone: 423-764-2299
  • Fax: 423-968-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301011
License Number StateVA

VIII. Authorized Official

Name: JOHN CHRISTOPHER ALLEN
Title or Position: CHIEF MANAGER/PODIATRIST
Credential: D.P.M.
Phone: 423-764-2299