| Restoration Recovery, Pllc | |
|
6141 Shallowford Rd Ste 100 Chattanooga TN 37421-1663 | |
| (423) 498-2000 | |
| (423) 498-2001 |
| Full Name | Restoration Recovery, Pllc |
|---|---|
| Speciality | Preventive Medicine |
| Location | 6141 Shallowford Rd Ste 100, Chattanooga, Tennessee |
| Authorized Official Name and Position | Michelle Paolucci (FACILITY DIRECTOR) |
| Authorized Official Contact | 4234982005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restoration Recovery, Pllc 6141 Shallowford Rd Ste 100 Chattanooga TN 37421-1663 Ph: (423) 498-2000 | Restoration Recovery, Pllc 6141 Shallowford Rd Ste 100 Chattanooga TN 37421-1663 Ph: (423) 498-2000 |
| NPI Number | 1770011652 |
|---|---|
| Provider Enumeration Date | 05/23/2017 |
| Last Update Date | 07/20/2023 |
| Certification Date | 07/20/2023 |
| Medicare PECOS PAC ID | 2961777446 |
|---|---|
| Medicare Enrollment ID | O20171010000530 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770011652 | NPI | - | NPPES |
| 003147609A | Medicaid | GA | |
| Q028699 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 2083A0300X | Preventive Medicine - Addiction Medicine | (* (Not Available)) | Primary |
| Provider Name | Julie C Munson-jackson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952328874 PECOS PAC ID: 4486656691 Enrollment ID: I20070131000672 |
| Provider Name | Kathleen R Scott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316922404 PECOS PAC ID: 7517064785 Enrollment ID: I20070523000127 |
| Provider Name | Brenda D Barton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730469958 PECOS PAC ID: 4880867118 Enrollment ID: I20111102000627 |
| Provider Name | Tonya Michelle Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821497744 PECOS PAC ID: 8820219843 Enrollment ID: I20141016000713 |
| Provider Name | Joshua L Hare |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1811121924 PECOS PAC ID: 8123144243 Enrollment ID: I20171010001172 |
| Provider Name | Sanjivini V Jacob |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1629234521 PECOS PAC ID: 8729149794 Enrollment ID: I20200219000135 |
| Provider Name | Shelli M Hancock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679172787 PECOS PAC ID: 6507265154 Enrollment ID: I20210601002872 |
| Provider Name | Otis Brandon Forrester |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447362736 PECOS PAC ID: 6103836788 Enrollment ID: I20210902002267 |
| Provider Name | Ashley J Cofield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407304272 PECOS PAC ID: 6507244951 Enrollment ID: I20220526000768 |
| Provider Name | Justin E Reason |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790479301 PECOS PAC ID: 3375907181 Enrollment ID: I20230913000241 |
| Provider Name | Keith Nilsen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841426814 PECOS PAC ID: 3173926623 Enrollment ID: I20240102002890 |
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