Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG Pediatric Neurology, BHMA Pediatric Neurology JC, Ballad Health Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL STEVE KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
408 N STATE OF FRANKLIN RD, SUITE 31C, JOHNSON CITY, TN 37604-6089
(423) 431-4946
(423) 431-4947
Mailing address
408 N STATE OF FRANKLIN RD, SUITE 31C, JOHNSON CITY, TN 37604-6089
(423) 431-4946
(423) 431-4947
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134500218
—
VA
05
—
Q013693
—
TN
Enumeration date
06/15/2015
Last updated
05/02/2025
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