Healthcare Provider Details

I. General information

NPI: 1194459883
Provider Name (Legal Business Name): GATEWAY TREATMENT CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 KIKER ST
ELLIJAY GA
30540-3758
US

IV. Provider business mailing address

1821 W BROADWAY AVE
MARYVILLE TN
37801-5511
US

V. Phone/Fax

Practice location:
  • Phone: 706-703-2517
  • Fax: 706-273-2517
Mailing address:
  • Phone: 865-724-0852
  • Fax: 865-724-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: ZACHARY CHARLES TALBOTT
Title or Position: PRESIDENT
Credential: MSW
Phone: 865-724-0852