Basic Information
| Provider Information | |||||||||
| NPI: | 1629428370 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APPALACHIAN REGIONAL MEDICAL ASSOCIATES INC | ||||||||
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| OtherOrganizationName: | THE HARRIET AND CHARLES DAVANT MEDICAL CLINIC AT CHESTNUT RIDGE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 623 CHESTNUT RIDGE PARKWAY | ||||||||
| Address2: | |||||||||
| City: | BLOWING ROCK | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286050000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282624133 | ||||||||
| FaxNumber: | 8282624103 | ||||||||
| Practice Location | |||||||||
| Address1: | 623 CHESTNUT RIDGE PARKWAY | ||||||||
| Address2: | |||||||||
| City: | BLOWING ROCK | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286050000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282624133 | ||||||||
| FaxNumber: | 8282624103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2016 | ||||||||
| LastUpdateDate: | 06/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | ETTA | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VP MEDICAL STAFF RELATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8282624133 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.