Organization
WATAUGA SURGICAL PARTNERS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM MARDEN (CHIEF EXECUTIVE OFFICER)
(423) 282-9011
Entity
Organization
Contact information
Practice address
10425 WALLACE ALLEY STREET, KINGSPORT, TN 37663
(423) 282-9011
(423) 282-0035
Mailing address
2410 SUSANNAH STREET, JOHNSON CITY, TN 37601
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
12/15/2022
Last updated
12/15/2022
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