Provider Demographics
NPI:1639190846
Name:BLUE RIDGE NEUROLOGY ASSOCIATES P.C.
Entity Type:Organization
Organization Name:BLUE RIDGE NEUROLOGY ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-224-4183
Mailing Address - Street 1:2012 BROOKSIDE DR
Mailing Address - Street 2:STE. 8
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4645
Mailing Address - Country:US
Mailing Address - Phone:423-224-4183
Mailing Address - Fax:423-224-4180
Practice Address - Street 1:2012 BROOKSIDE DR
Practice Address - Street 2:STE. 8
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4645
Practice Address - Country:US
Practice Address - Phone:423-224-4183
Practice Address - Fax:423-224-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD26480174400000X
TNMD20022174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty