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General NPI Number Information
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NPI Number | 1881687689
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE RADIOLOGY, P.C.
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 111 STEVENSWOOD DR
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City | BRISTOL
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State | TN
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Zip | 37620-7308
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Country | US
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Telephone | 423-968-1144
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Fax | 423-968-3453
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Provider Business Mailing Address
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Address Line | 111 STEVENSWOOD DR
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City | BRISTOL
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State | TN
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Zip | 37620-7308
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Country | US
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Telephone | 423-968-1144
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Fax | 423-968-3453
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MICHELLE SNYDER
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Credential |
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Telephone | 423-301-6567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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