Healthcare Provider Details

I. General information

NPI: 1427463231
Provider Name (Legal Business Name): RECOVERY PHYSICIAN GROUP OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 BLACK BEAR RDG
SAUTEE GA
30571-3500
US

IV. Provider business mailing address

PO BOX 2323
BRENTWOOD TN
37024-2323
US

V. Phone/Fax

Practice location:
  • Phone: 470-539-6905
  • Fax:
Mailing address:
  • Phone: 615-345-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD RODGERS
Title or Position: COO
Credential:
Phone: 615-345-3200