Provider Demographics
NPI:1508305087
Name:WATAUGA RECOVERY CENTER,PC
Entity Type:Organization
Organization Name:WATAUGA RECOVERY CENTER,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:REACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-631-0432
Mailing Address - Street 1:3114 BROWNS MILL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1417
Mailing Address - Country:US
Mailing Address - Phone:423-631-0432
Mailing Address - Fax:423-631-0284
Practice Address - Street 1:21563 WHYTE HARDEE BLVD
Practice Address - Street 2:
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927
Practice Address - Country:US
Practice Address - Phone:843-547-4733
Practice Address - Fax:843-547-4734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40502207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty