Organization
ENSEMBLE RECOVERY ENTERPRISES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEAVER T SHATTUCK MD (CHIEF MEDICAL OFFICER)
(865) 770-3838
Entity
Organization
Contact information
Practice address
417 HOLLY ST, KNOXVILLE, TN 37917-7815
(865) 770-4003
(865) 246-2106
Mailing address
PO BOX 5777, MARYVILLE, TN 37802-5777
(865) 246-2104
(865) 246-2106
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3550
TN
207R00000X
Internal Medicine Physician
27892
TN
363LF0000X
Family Nurse Practitioner
21354
TN
Other
Enumeration date
09/29/2017
Last updated
09/29/2017
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