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Patrick David South

Family Medicine

Allopathic & Osteopathic Physicians

130 W Ravine Rd, Kingsport, TN 37660-3837

PECOS Enrollment

This provider is enrolled in PECOS as PATRICK SOUTH.

Based on the most recent information from CMS, provider Patrick David South is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1417693284
Provider Type
Individual
Full Name
South, Patrick David
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
5/5/2022
Last Updated
12/12/2025

Contact Information

Practice Location

130 W Ravine Rd, Kingsport, TN 37660-3837

(423) 433-6625

(423) 723-2669

Mailing Location

121 Boone Ridge Dr Ste 1002, Johnson City, TN 37615-4993

(423) 433-6625

(423) 723-2669

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 74943 Tennessee

Patrick David South

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Barakam, Neha

Brummel, Mark

Bates, Chad

Shafer, Jennifer Gordon

Blue Ridge Medical Management Corporation

Lee, Robert

Blue Ridge Medical Management Corp

Blue Ridge Medical Management Corp

Robbins, Sherry L

Oberdick, Wendy Tipton