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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