MEDICARE: WATAUGA RECOVERY CENTER MORRISTOWN P.C.

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	207QA0401X	Addiction Medicine (Family Medicine) Physician		TN

General Provider Information

NPI Number	:	1831640937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATAUGA RECOVERY CENTER MORRISTOWN P.C.

Provider Business Mailing Address
First Line	:	1369 W ANDREW JOHNSON HWY
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814
Country	:	US
Telephone Number	:	423-586-3249
Fax Number	:	423-586-3250

Provider Business Practice Location Address
First Line	:	1369 W ANDREW JOHNSON HWY
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604
Country	:	US
Telephone Number	:	423-586-3249
Fax Number	:	423-586-3250

Authorized Official
Title or Position	:	EXECUTIVE ASSISTANT
Name	:	MRS. BETTY C LINKE
Credential	:
Telephone Number	:	423-431-0432

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	10/24/2016

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