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General NPI Number Information
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NPI Number | 1104286194
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Entity Type | Organization
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Legal Business Name | WELLMONT MEDICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 4485 W STONE DR SUITE 200
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City | KINGSPORT
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State | TN
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Zip | 37660-1050
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Country | US
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Telephone | 423-224-3150
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Fax | 423-224-3169
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Provider Business Mailing Address
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Address Line | 105 W STONE DR SUITE 6A
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City | KINGSPORT
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State | TN
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Zip | 37660-3365
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Country | US
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Telephone | 423-408-7220
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Fax | 423-408-7405
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Authorized Official
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Title or Position | WHS SR VP FINANCE
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Name | TODD J DOUGAN
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Credential |
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Telephone | 423-230-8512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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