Healthcare Provider Details

I. General information

NPI: 1831640937
Provider Name (Legal Business Name): WATAUGA RECOVERY CENTER MORRISTOWN P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369 W ANDREW JOHNSON HWY
JOHNSON CITY TN
37604
US

IV. Provider business mailing address

1369 W ANDREW JOHNSON HWY
MORRISTOWN TN
37814
US

V. Phone/Fax

Practice location:
  • Phone: 423-586-3249
  • Fax: 423-586-3250
Mailing address:
  • Phone: 423-586-3249
  • Fax: 423-586-3250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. BETTY C LINKE
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 423-431-0432