Organization
MINDFUL RECOVERY ADDICTION SPECIALIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL CAUDILL (ENROLLMENT CONSULTANT)
(615) 521-9097
Entity
Organization
Contact information
Practice address
20463 ALBERTA ST, ONEIDA, TN 37841
(423) 286-3292
Mailing address
20463 ALBERTA ST, ONEIDA, TN 37841-3509
(423) 286-3292
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
04/09/2018
Last updated
07/03/2018
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