Healthcare Provider Details

I. General information

NPI: 1568913663
Provider Name (Legal Business Name): WATAUGA RECOVERY CENTER NEWPORT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 HERITAGE BLVD
NEWPORT TN
37821-4257
US

IV. Provider business mailing address

330 HERITAGE BLVD
NEWPORT TN
37821-4257
US

V. Phone/Fax

Practice location:
  • Phone: 423-623-7043
  • Fax: 423-623-7046
Mailing address:
  • Phone: 423-623-7043
  • Fax: 423-623-7046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number StateTN

VIII. Authorized Official

Name: MRS. BETTY C LINKE
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 423-631-0432