Healthcare Provider Details

I. General information

NPI: 1841761574
Provider Name (Legal Business Name): NEW JOURNEY LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2497 S ROANE ST
HARRIMAN TN
37748-8670
US

IV. Provider business mailing address

621 STEEPLECHASE CT
RENO NV
89521-6250
US

V. Phone/Fax

Practice location:
  • Phone: 865-389-6991
  • Fax:
Mailing address:
  • Phone: 916-385-4849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN DOLORES
Title or Position: CEO
Credential: JD, PHD
Phone: 916-385-4849