Healthcare Provider Details

I. General information

NPI: 1689145880
Provider Name (Legal Business Name): RECHARGE RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 NISSAN DR STE 502
SMYRNA TN
37167-4311
US

IV. Provider business mailing address

437 NISSAN DR STE 502
SMYRNA TN
37167-4311
US

V. Phone/Fax

Practice location:
  • Phone: 615-462-5138
  • Fax: 615-462-5138
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SHELIA MORTON
Title or Position: BILLING AND CREDENTIALING SPECIALIS
Credential:
Phone: 901-488-7447