Provider Demographics
NPI:1730668575
Name:KINGSPORT FAMILY MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:KINGSPORT FAMILY MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-715-6588
Mailing Address - Street 1:217 E SPRINGBROOK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1733
Mailing Address - Country:US
Mailing Address - Phone:423-434-2080
Mailing Address - Fax:
Practice Address - Street 1:935 WILCOX CT STE 115
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5170
Practice Address - Country:US
Practice Address - Phone:423-444-9801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care