Basic Information
| Provider Information | |||||||||
| NPI: | 1518508993 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WATAUGA ORTHOPAEDICS, PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 SUSANNAH ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376011748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232829011 | ||||||||
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| Practice Location | |||||||||
| Address1: | 340 STEELES RD | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232829011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2019 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4232829582 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.