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General NPI Number Information
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NPI Number | 1528223633
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE MOUNTAIN INTERNAL MEDICINE PC
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 17 BARCLAY ST
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City | ELLIJAY
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State | GA
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Zip | 30540-3309
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Country | US
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Telephone | 706-635-7231
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Fax | 706-635-7232
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Provider Business Mailing Address
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Address Line | 17 BARCLAY ST
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City | ELLIJAY
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State | GA
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Zip | 30540-3309
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Country | US
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Telephone | 706-635-7231
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Fax | 706-635-7232
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Authorized Official
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Title or Position | PRESIDENT/OVNER
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Name | DR. ROBERT K BOND
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Credential | MD
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Telephone | 706-635-7231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 020408
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License Number State | GA
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