NPIMap

Organization Active NPI

Watauga Lake Family Medicine PC

  • Family Medicine Physician
  • Butler, TN
National Provider Identifier
1457548406
Registry record updated Oct 3, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD0000041068 Issued in TN
Legal business name
WATAUGA LAKE FAMILY MEDICINE PC
Practice address
140 McQueen St.
Butler, TN 37640
Phone
(423) 768-0195
NPI assigned
Oct 3, 2007
Last updated
Oct 3, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Amy R. Miller
Title
Business Manager
Phone
(336) 982-2158

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X MD0000041068 TN Primary

Addresses

Primary practice location

140 McQueen St.
Butler, TN 37640

Mailing address

138 N Fork New River Rd
Lansing, NC 28643-9130
Phone (336) 982-2158

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191369600000",
    "number": "1457548406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 N FORK NEW RIVER RD",
            "city": "LANSING",
            "state": "NC",
            "postal_code": "286439130",
            "telephone_number": "336-982-2158",
            "fax_number": "336-982-3373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 MCQUEEN ST.",
            "city": "BUTLER",
            "state": "TN",
            "postal_code": "37640",
            "telephone_number": "423-768-0195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATAUGA LAKE FAMILY MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-03",
        "last_updated": "2007-10-03",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "336-982-2158",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD0000041068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Butler, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.