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Contact Information

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
408 N STATE OF FRANKLIN RD
SUITE 31E
JOHNSON CITY, TN37604-6089
 Phone: 423-431-4946
 Fax: 423-431-4947
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Family

363LF0000X 50 Nurse Practitioner
 

Pediatric Gastroenterology

2080P0206X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for BLUE RIDGE MEDICAL MANAGEMENT CORPORATION · (Female)

NPI # 1619349578
Status Active
Credentials
Entity Individual
Enumeration date 10/30/2015
Last updated 05/02/2025 - More than a year ago
Sole proprietor 1 Not specified
Identifiers
  • TN Medicaid Q020024
  • VA Medicaid 1619349578
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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