Healthcare Provider Details

I. General information

NPI: 1629987847
Provider Name (Legal Business Name): DLV MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 SUSANNAH ST STE 1
JOHNSON CITY TN
37601-1765
US

IV. Provider business mailing address

2408 SUSANNAH ST STE 1
JOHNSON CITY TN
37601-1765
US

V. Phone/Fax

Practice location:
  • Phone: 828-280-3957
  • Fax:
Mailing address:
  • Phone: 828-280-3957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON DELLA VECCHIA
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 828-280-3957