Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG PEDS KPT
Organization subpart
No
Provider details
NPI number
Authorized official
CARL S KILGORE (PRESIDENT)
(423) 915-5100
Entity
Organization
Contact information
Practice address
2204 PAVILION DR, SUITE 210, KINGSPORT, TN 37660-4657
(423) 224-3933
(423) 224-3934
Mailing address
2204 PAVILION DR, SUITE 210, KINGSPORT, TN 37660-4657
(423) 224-3933
(423) 224-3934
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
12/22/2010
Last updated
12/22/2010
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