NEW LIFE MEDICINE NPI 1114462215

NPI Information

  • NPI: 1114462215
  • Provider Name: NEW LIFE MEDICINE
  • Classification: Internal Medicine - 207RA0401X
  • Specialization: Addiction Medicine
  • Entity Type: Organization
  • Former Legal Business Name: NEW LIFE MEDICINE
  • CLIA Number: 49D2268571
  • Address: 2408 SUSANNAH ST STE 1
    JOHNSON CITY, TN
    ZIP 37601
  • Phone: (423) 434-6677

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NPI Details

NEW LIFE MEDICINE is an addiction medicine internal medicine in Johnson City, TN. The provider is an internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. NEW LIFE MEDICINE NPI is 1114462215. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is New Life Medicine.

The provider's business location address is:

2408 SUSANNAH ST STE 1
JOHNSON CITY, TN
ZIP 37601-765
Phone: (423) 434-6677
Fax: (423) 461-0000

The provider's authorized official is Daniel Tackling .
The authorized official title is Cfo and has the following contact phone number (423) 434-6677.

The CLIA number assigned to this NPI record is 49D2268571 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/27/2016 and was last updated on 11/6/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RA0401XInternal MedicineAddiction MedicineYes
2251S00000XCommunity/Behavioral HealthNo
3261QM1300XClinic/CenterMulti-SpecialtyNo
4261QR0405XClinic/CenterRehabilitation, Substance Use DisorderNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12017139831MEDICAIDVIRGINIA
27100519480MEDICAIDKENTUCKY
3Q026013MEDICAIDTENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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