Healthcare Provider Details

I. General information

NPI: 1215856638
Provider Name (Legal Business Name): BLUE RIDGE DIGESTIVE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 WINNBROOK LN
ROANOKE VA
24018-7906
US

IV. Provider business mailing address

6015 WINNBROOK LN
ROANOKE VA
24018-7906
US

V. Phone/Fax

Practice location:
  • Phone: 404-510-8154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JONH JAMES PINEDA-BONILLA
Title or Position: OWNER
Credential:
Phone: 404-510-8154