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General NPI Number Information
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NPI Number | 1619409489
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Entity Type | Organization
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Legal Business Name | WATAUGA RECOVERY CENTER GREENEVILLE
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | 819 W CHURCH STREET
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City | GREENEVILLE
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State | TN
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Zip | 37745
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Country | US
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Telephone | 423-823-5550
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Fax | 423-823-9724
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Provider Business Mailing Address
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Address Line | 819 W CHURCH ST
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City | GREENEVILLE
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State | TN
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Zip | 37745-3259
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Country | US
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Telephone | 423-823-5550
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Fax | 423-823-9724
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RALPH T REACH
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Credential | M.D.
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Telephone | 423-823-5550
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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 | 41263
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License Number State | TN
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