# MOUNTAIN REGION FAMILY MEDICINE, PC

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

## Provider details

- **NPI number:** 1710990601
- **Authorized official:** WANDA TRENT (CORPORATE SECRETARY)
- **Authorized official phone:** (423) 230-2109

## Contact information

- **Practice address:** 101 PROFESSIONAL PARK PVT DR, KINGSPORT, TN 37663-2288
- **Practice address phone:** (423) 239-7300
- **Practice address fax:** (423) 239-8581
- **Mailing address:** 101 PROFESSIONAL PARK PVT DR, KINGSPORT, TN 37663-2288
- **Mailing address phone:** (423) 239-7300
- **Mailing address fax:** (423) 239-8581

## Taxonomy

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

## Other

- **Enumeration date:** 08/14/2006
- **Last updated:** 12/14/2017