Organization · NPI-2

30:17 Recovery

Internal Medicine, Addiction Medicine · Jackson, TN

NPI number1679331284
StatusActive
Last updated in NPPESMar 8, 2024

Details

NPI
1679331284
Entity type
Organization (NPI-2)
Legal business name
30:17 Recovery
Organization subpart
No
Enumeration date
Mar 8, 2024
Last updated
Mar 8, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207RA0401X Internal Medicine, Addiction Medicine––Yes
101YA0400X Counselor, Addiction (Substance Use Disorder)––

Practice location

188 Carriage House Dr
Jackson, TN 38305-3969

Phone 731-215-0049 · Fax 800-418-1395

Mailing address

188 Carriage House Dr
Jackson, TN 38305-3969

Phone 731-215-0049 · Fax 800-418-1395

Authorized official

Melissa Mcbroom
Director
7312150449

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