Organization
HOLSTON MEDICAL GROUP PC
Active
Other names
Path Reference Lab
Organization subpart
No
Provider details
NPI number
Authorized official
AUDRA LAWSON (CONTRACT MANAGER)
(423) 857-2066
Entity
Organization
Contact information
Practice address
105 W STONE DR, 1H, KINGSPORT, TN 37660-3256
(423) 392-6200
(423) 392-6593
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2066
(423) 857-2030
Taxonomy
Speciality
Code
Description
License number
State
246RM2200X
Medical Laboratory Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000100137
—
VA
Enumeration date
12/19/2006
Last updated
12/08/2010
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