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General NPI Number Information
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NPI Number | 1356433155
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE FAMILY PHYSICIANS, PLLC
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 03/06/2009
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Provider Practice Location Address
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Address Line | 2605 BLUE RIDGE RD SUITE 300
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City | RALEIGH
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State | NC
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Zip | 27607-6475
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Country | US
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Telephone | 919-787-3448
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Fax | 919-232-0006
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Provider Business Mailing Address
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Address Line | 2605 BLUE RIDGE RD SUITE 300
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City | RALEIGH
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State | NC
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Zip | 27607-6475
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Country | US
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Telephone | 919-787-3448
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Fax | 919-232-0006
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KIRSTEN H. AVERY
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Credential | MD
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Telephone | 919-787-3448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 108015
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License Number State | NC
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