Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
Ballad Health Medical Associates, MSMG Counseling Services JC, BHMA Counseling Services JC
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
525 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-8213
(423) 302-4380
Mailing address
509 MED TECH PKWY STE 100, JOHNSON CITY, TN 37604-2579
(423) 302-6567
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154779817
—
VA
05
—
Q022855
—
TN
Enumeration date
06/02/2016
Last updated
09/27/2022
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