Healthcare Provider Details

I. General information

NPI: 1386282036
Provider Name (Legal Business Name): CONCORD RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S CONCORD ST STE 108
KNOXVILLE TN
37919-3339
US

IV. Provider business mailing address

601 S CONCORD ST STE 108
KNOXVILLE TN
37919-3339
US

V. Phone/Fax

Practice location:
  • Phone: 865-985-0371
  • Fax: 865-985-0649
Mailing address:
  • Phone: 865-985-0371
  • Fax: 865-985-0649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CRISSY L SHANK
Title or Position: BILLING
Credential:
Phone: 931-761-5732