| Appalachian Development Llc | |
|
129 Montgomery Ln Maryville TN 37803-5649 | |
| (865) 681-1224 | |
| (865) 681-5185 |
| Full Name | Appalachian Development Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 129 Montgomery Ln, Maryville, Tennessee |
| Authorized Official Name and Position | Karin Love (OFFICE MANAGER) |
| Authorized Official Contact | 8656815185 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Appalachian Development Llc 129 Montgomery Ln Maryville TN 37803-5649 Ph: (865) 681-1224 | Appalachian Development Llc 129 Montgomery Ln Maryville TN 37803-5649 Ph: (865) 681-1224 |
| NPI Number | 1184740763 |
|---|---|
| Provider Enumeration Date | 03/22/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2466356555 |
|---|---|
| Medicare Enrollment ID | O20031120000776 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184740763 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Russell Gibson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821048638 PECOS PAC ID: 0345144432 Enrollment ID: I20101102000017 |
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