Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
BHMA Pediatric Urology Johnson City, MSMG Pediatric Urology Johnson City, Ballad Health Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
CARL KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
408 N STATE OF FRANKLIN RD STE 31F, JOHNSON CITY, TN 37604-6088
(423) 431-4946
(423) 431-4947
Mailing address
408 N STATE OF FRANKLIN RD STE 31F, JOHNSON CITY, TN 37604-6088
(423) 431-4946
(423) 431-4947
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
—
—
Other
Enumeration date
07/11/2018
Last updated
03/29/2019
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