Healthcare Provider Details

I. General information

NPI: 1427834225
Provider Name (Legal Business Name): TENNESSEE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 DOWNTOWN WEST BLVD STE 119
KNOXVILLE TN
37919-5488
US

IV. Provider business mailing address

1630 DOWNTOWN WEST BLVD STE 119
KNOXVILLE TN
37919-5488
US

V. Phone/Fax

Practice location:
  • Phone: 865-409-4309
  • Fax:
Mailing address:
  • Phone: 865-409-4309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RACHELLE L SELLS
Title or Position: OWNER
Credential:
Phone: 931-761-5732