Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
DBA Blue Ridge Psychiatry
Organization subpart
No
Provider details
NPI number
Authorized official
C STEVEN KILGORE (SENIOR VICE PRESIDENT)
(423) 915-5185
Entity
Organization
Contact information
Practice address
2300 PAVILION DR, KINGSPORT, TN 37660-4622
(423) 857-5720
(423) 857-5720
Mailing address
2300 PAVILION DR, KINGSPORT, TN 37660-4622
(423) 857-5720
(423) 857-5720
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3377134
—
TN
Enumeration date
08/11/2006
Last updated
08/22/2020
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