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General NPI Number Information
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NPI Number | 1386282036
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Entity Type | Organization
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Legal Business Name | CONCORD RECOVERY CENTER
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 601 S CONCORD ST STE 108
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City | KNOXVILLE
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State | TN
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Zip | 37919-3339
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Country | US
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Telephone | 865-985-0371
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Fax | 865-985-0649
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Provider Business Mailing Address
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Address Line | 601 S CONCORD ST STE 108
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City | KNOXVILLE
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State | TN
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Zip | 37919-3339
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Country | US
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Telephone | 865-985-0371
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Fax | 865-985-0649
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Authorized Official
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Title or Position | BILLING
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Name | CRISSY L SHANK
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Credential |
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Telephone | 931-761-5732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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