MEDICARE: EXODUS RECOVERY CENTER, PLLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LA0401X	Addiction Medicine (Anesthesiology) Physician	MD20094	TN

General Provider Information

NPI Number	:	1184047516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXODUS RECOVERY CENTER, PLLC.

Provider Business Mailing Address
First Line	:	4200 MARTIN MILL PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-3033
Country	:	US
Telephone Number	:	252-414-7395
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 MARTIN MILL PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-3033
Country	:	US
Telephone Number	:	252-414-7395
Fax Number	:

Authorized Official
Title or Position	:	ORGANIZING MEMBER
Name	:	DR. DAVID G NEWMAN
Credential	:	M.D.
Telephone Number	:	252-414-7395

Provider Enumeration Date	:	01/21/2014
Last Update Date	:	01/21/2014

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