MEDICARE: DOCTORS ASSISTED WELLNESS AND RECOVERY, 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	207QA0401X	Addiction Medicine (Family Medicine) Physician
2	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician

General Provider Information

NPI Number	:	1902762628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS ASSISTED WELLNESS AND RECOVERY, PLLC

Provider Business Mailing Address
First Line	:	2406 SUSANNAH ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1725
Country	:	US
Telephone Number	:	423-928-1393
Fax Number	:	888-204-4075

Provider Business Practice Location Address
First Line	:	2406 SUSANNAH ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1725
Country	:	US
Telephone Number	:	423-928-1393
Fax Number	:	888-204-4075

Authorized Official
Title or Position	:	CEO
Name	:	JOY TINO
Credential	:
Telephone Number	:	423-928-1393

Provider Enumeration Date	:	12/26/2025
Last Update Date	:	12/26/2025

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