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General NPI Number Information
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NPI Number | 1538989371
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 800 S MOHAWK DR STE C
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City | ERWIN
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State | TN
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Zip | 37650-2124
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Country | US
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Telephone | 423-735-4750
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Fax | 423-735-3535
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Provider Business Mailing Address
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Address Line | 800 S MOHAWK DR STE C
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City | ERWIN
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State | TN
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Zip | 37650-2124
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Country | US
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Telephone | 423-735-4750
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Fax | 423-735-3535
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Authorized Official
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Title or Position | DIRECTOR
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Name | JUANITA L HARWOOD
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Credential |
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Telephone | 423-302-6565
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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 |
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License Number State |
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