Organization
FRONTIER HEALTH
Active
Other names
Magnolia Ridge
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTI LYNN BLALOCK (DIRECTOR OF CONTRACTING/REG. COMP.)
(423) 467-3741
Entity
Organization
Contact information
Practice address
208 E UNAKA AVE, JOHNSON CITY, TN 37601-4626
(423) 906-0940
(423) 467-3644
Mailing address
1167 SPRATLIN PARK DR, GRAY, TN 37615-6205
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
2084P0800X
Psychiatry Physician
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
430
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
12/27/2006
Last updated
10/13/2025
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