# MOUNTAIN REGION FAMILY MEDICINE, PC

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

## Provider details

- **NPI number:** 1831467067
- **Authorized official:** MS. WANDA Y TRENT (CORPORATE SECRETARY)
- **Authorized official phone:** (423) 230-2109

## Contact information

- **Practice address:** 444 CLINCHFIELD STREET, STE 201, KINGSPORT, TN 37660-3683
- **Practice address phone:** (423) 230-2100
- **Practice address fax:** (423) 230-2112
- **Mailing address:** 444 CLINCHFIELD STREET, STE 201, KINGSPORT, TN 37660-3683
- **Mailing address phone:** (423) 230-2100
- **Mailing address fax:** (423) 230-2112

## Taxonomy

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

## Other

- **Enumeration date:** 12/02/2011
- **Last updated:** 03/10/2017