Healthcare Provider Details

I. General information

NPI: 1013273937
Provider Name (Legal Business Name): ASSOCIATED ORTHOPAEDICS OF KINGSPORT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 COEBURN AVE SW
NORTON VA
24273-2606
US

IV. Provider business mailing address

2202 N JOHN B DENNIS HWY SUITE 100
KINGSPORT TN
37660-5904
US

V. Phone/Fax

Practice location:
  • Phone: 276-679-0800
  • Fax: 423-857-8129
Mailing address:
  • Phone: 423-245-3161
  • Fax: 423-857-8129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA J WELLS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 423-230-3870