Provider Demographics
NPI:1154462117
Name:EMDEE CLINICA, PLLC
Entity Type:Organization
Organization Name:EMDEE CLINICA, PLLC
Other - Org Name:EMDEE CLINICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAFP
Authorized Official - Phone:423-341-3040
Mailing Address - Street 1:23164 KESTREL DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-5070
Mailing Address - Country:US
Mailing Address - Phone:423-341-3040
Mailing Address - Fax:
Practice Address - Street 1:23164 KESTREL DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202
Practice Address - Country:US
Practice Address - Phone:423-341-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052898261QP2300X
TN37264261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA386590OtherANTHEM, BC/BS OF VIRGINIA
VAP00042666OtherRAILROAD MEDICARE
VAG49192Medicare UPIN
VAC08634Medicare PIN