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General NPI Number Information
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NPI Number | 1194943092
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE GENERAL SURGERY, PC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8017 NINETEEN E HIGHWAY
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City | SPRUCE PINE
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State | NC
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Zip | 28777
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Country | US
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Telephone | 828-765-9933
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Fax |
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Provider Business Mailing Address
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Address Line | 8017 NINETEEN E HIGHWAY
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City | SPRUCE PINE
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State | NC
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Zip | 28777
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Country | US
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Telephone | 828-765-9933
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Fax |
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Authorized Official
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Title or Position | SECRETARY TREASURER
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Name | DEBORAH A ROBINSON
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Credential |
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Telephone | 828-765-9933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 9601047
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License Number State | NC
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