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General NPI Number Information
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NPI Number | 1619770088
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Entity Type | Organization
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Legal Business Name | HOLSTON MEDICAL GROUP, PC
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 2340 KNOB CREEK RD STE 720
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2977
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Country | US
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Telephone | 423-926-6112
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | KINGSPORT
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State | TN
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Zip | 37662-0009
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Country | US
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Telephone | 423-857-2000
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Fax |
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | MR. BRIAN LEWIS
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Credential |
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Telephone | 423-392-7233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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