MEDICARE: RECOVERY PHYSICIAN GROUP OF TENNESSEE, LLC

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	103TA0400X	Addiction (Substance Use Disorder) Psychologist

General Provider Information

NPI Number	:	1275799892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY PHYSICIAN GROUP OF TENNESSEE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2323
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37024-2323
Country	:	US
Telephone Number	:	957-587-7771
Fax Number	:

Provider Business Practice Location Address
First Line	:	3175 LENOX PARK BLVD STE 412
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-4256
Country	:	US
Telephone Number	:	954-587-7771
Fax Number	:

Authorized Official
Title or Position	:	TEAM LEADER
Name	:	YVONNE BELL
Credential	:
Telephone Number	:	954-587-7771

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	08/11/2008

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