Organization
LEGACY PLACE RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA DAVENPORT PA-C (CO-OWNER)
(931) 808-7504
Entity
Organization
Contact information
Practice address
711 E OLDHAM AVE, KNOXVILLE, TN 37917-5566
(865) 471-8326
Mailing address
5907 CLINTON HWY, KNOXVILLE, TN 37912-2547
(931) 808-7504
Taxonomy
Speciality
Code
Description
License number
State
2084P0802X
Addiction Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/07/2023
Last updated
03/07/2023
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