Organization
EAST TENNESSEE RECOVERY, PLLC
Active
Other names
New Life Medicine, New Life Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL TACKLING (CFO)
(423) 434-6677
Entity
Organization
Contact information
Practice address
2408 SUSANNAH ST STE 1, JOHNSON CITY, TN 37601-1765
(423) 434-6677
(423) 461-0000
Mailing address
2408 SUSANNAH ST STE 1, JOHNSON CITY, TN 37601-1765
(423) 434-6677
(423) 461-0000
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2017139831
—
VA
05
—
7100519480
—
KY
05
—
Q026013
—
TN
Enumeration date
12/27/2016
Last updated
12/16/2025
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