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Organization

DRS MONTENEGRO & DE WIT

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ALBERTINE DE WIT M.D. (OWNER)
(423) 928-3051
Entity
Organization

Contact information

Practice address
310 N STATE OF FRANKLIN RD, SUITE 201, JOHNSON CITY, TN 37604-6008
(423) 928-3051
(423) 928-8840
Mailing address
310 N STATE OF FRANKLIN RD, SUITE 201, JOHNSON CITY, TN 37604-6008
(423) 928-3051
(423) 928-8840

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
013647
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
129760
TRIGON BCBS
TN
01
15491
BCBS
TN
05
3382675
TN
Enumeration date
09/21/2006
Last updated
08/22/2020
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