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General NPI Number Information
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NPI Number | 1992596878
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Entity Type | Organization
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Legal Business Name | WELLMONT MEDICAL ASSOCIATES INC
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 6419 BRISTOL HWY
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City | PINEY FLATS
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State | TN
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Zip | 37686-5208
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Country | US
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Telephone | 423-538-5202
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Fax | 423-538-8208
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Provider Business Mailing Address
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Address Line | 1021 W OAKLAND AVE STE 310
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2192
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Country | US
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Telephone | 423-302-6565
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Fax |
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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