# WATAUGA LAKE FAMILY MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457548406
- **Authorized official:** MS. AMY R. MILLER (BUSINESS MANAGER)
- **Authorized official phone:** (336) 982-2158

## Contact information

- **Practice address:** 140 MCQUEEN ST., BUTLER, TN 37640
- **Practice address phone:** (423) 768-0195
- **Mailing address:** 138 N FORK NEW RIVER RD, LANSING, NC 28643-9130
- **Mailing address phone:** (336) 982-2158
- **Mailing address fax:** (336) 982-3373

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD0000041068 | TN | Yes |

## Other

- **Enumeration date:** 10/03/2007
- **Last updated:** 10/03/2007