Provider Demographics
NPI:1184047516
Name:EXODUS RECOVERY CENTER, PLLC.
Entity type:Organization
Organization Name:EXODUS RECOVERY CENTER, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-414-7395
Mailing Address - Street 1:4200 MARTIN MILL PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-3033
Mailing Address - Country:US
Mailing Address - Phone:252-414-7395
Mailing Address - Fax:
Practice Address - Street 1:4200 MARTIN MILL PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-3033
Practice Address - Country:US
Practice Address - Phone:252-414-7395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD20094207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Single Specialty