Provider Demographics
NPI:1992983381
Name:MOUNTAIN FAMILY MEDICAL, PLLC
Entity type:Organization
Organization Name:MOUNTAIN FAMILY MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCE PRACTICE NURSE
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:423-886-4942
Mailing Address - Street 1:1807 TAFT HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SIGNAL MTN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-3528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1807 TAFT HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:SIGNAL MTN
Practice Address - State:TN
Practice Address - Zip Code:37377-3528
Practice Address - Country:US
Practice Address - Phone:423-886-4942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012169261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care