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General NPI Number Information
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NPI Number | 1578369609
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Entity Type | Organization
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Legal Business Name | RENEWAL ADDICTION CONSULTANTS, LLC
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 246 N WATKINS ST
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City | MEMPHIS
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State | TN
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Zip | 38104-7106
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Country | US
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Telephone | 615-406-7791
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Fax |
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Provider Business Mailing Address
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Address Line | 4543 S CAROTHERS RD
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City | FRANKLIN
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State | TN
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Zip | 37064-4090
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER, CREDENTIALING
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Name | ALICIA NEAL
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Credential |
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Telephone | 615-300-7871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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