# BLUE RIDGE MEDICAL MANAGEMENT CORP

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

## Provider details

- **NPI number:** 1588326839
- **Authorized official:** LARAINE DOVER (DIRECTOR)
- **Authorized official phone:** (423) 952-2124

## Contact information

- **Practice address:** 1905 AMERICAN WAY, KINGSPORT, TN 37660-5882
- **Practice address phone:** (423) 578-8451
- **Practice address fax:** (423) 230-8224
- **Mailing address:** 509 MED TECH PKWY STE 100, JOHNSON CITY, TN 37604-2579
- **Mailing address phone:** (423) 302-6565

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/13/2021
- **Last updated:** 10/13/2021