Healthcare Provider Details

I. General information

NPI: 1609327915
Provider Name (Legal Business Name): WATAUGA DUFFIELD MEDICAL CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 ROSS CARTER BLVD
DUFFIELD VA
24244-5117
US

IV. Provider business mailing address

198 ROSS CARTER BLVD
DUFFIELD VA
24244-5117
US

V. Phone/Fax

Practice location:
  • Phone: 276-431-2900
  • Fax: 276-431-2904
Mailing address:
  • Phone: 276-431-2900
  • Fax: 276-431-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0101041174
License Number StateVA

VIII. Authorized Official

Name: MRS. BETTY C LINKE
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 423-631-0432