Healthcare Provider Details

I. General information

NPI: 1285599431
Provider Name (Legal Business Name): CROSSROADS TREATMENT CENTERS OF TENNESSEE, P.C.
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

3114 BROWNS MILL RD
JOHNSON CITY TN
37604-1417
US

IV. Provider business mailing address

PO BOX 749057
ATLANTA GA
30374-9057
US

V. Phone/Fax

Practice location:
  • Phone: 800-805-6989
  • Fax: 864-558-8511
Mailing address:
  • Phone: 800-805-6989
  • Fax: 864-558-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: RUPERT MCCORMAC IV
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 800-805-6989