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General NPI Number Information
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NPI Number | 1851902639
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Entity Type | Organization
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Legal Business Name | ADDICTION RECOVERY CENTER OF EAST TN
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 3763 HIGHWAY 11 W
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City | BLOUNTVILLE
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State | TN
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Zip | 37617-3407
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Country | US
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Telephone | 423-279-3860
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Fax | 423-279-3861
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Provider Business Mailing Address
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Address Line | 3763 HIGHWAY 11 W
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City | BLOUNTVILLE
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State | TN
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Zip | 37617-3407
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Country | US
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Telephone | 423-279-3860
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Fax | 423-279-3861
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Authorized Official
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Title or Position | OWNER
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Name | DR. MACK LYNN HICKS
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Credential | MD
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Telephone | 423-914-3195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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