Healthcare Provider Details

I. General information

NPI: 1023973195
Provider Name (Legal Business Name): DIRECT MENTAL WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S ROAN ST
JOHNSON CITY TN
37601-5728
US

IV. Provider business mailing address

121 BOONE ST UNIT 141
JONESBOROUGH TN
37659-8006
US

V. Phone/Fax

Practice location:
  • Phone: 540-755-0098
  • Fax:
Mailing address:
  • Phone: 540-755-0098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN BUABBUD
Title or Position: OWNER
Credential: MD
Phone: 540-755-0098