30:17 Recovery

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

Legal business name

30:17 RECOVERY

Practice address

188 Carriage House Dr
Jackson, TN 38305-3969

Phone

(731) 215-0049

Fax

(800) 418-1395

NPI assigned

Mar 8, 2024

Last updated

Mar 8, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Melissa McBroom

Title

Director

Phone

(731) 215-0449

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gary McBride, MD

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1982671079

  Addiction Medicine

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709856000000",
    "number": "1679331284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 CARRIAGE HOUSE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053969",
            "telephone_number": "731-215-0049",
            "fax_number": "800-418-1395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 CARRIAGE HOUSE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053969",
            "telephone_number": "731-215-0049",
            "fax_number": "800-418-1395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "30:17 RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-08",
        "last_updated": "2024-03-08",
        "status": "A",
        "authorized_official_last_name": "MCBROOM",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "731-215-0449"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 1St Step Fitness
• 3 B Labs (Professional Medical Partners)
• 3Ba Consultants
• 45 Urgent Care, P.C.
• A & a Medical, LLC
• A Better Way to Care LLC
• A Home Away From Home Adult Day Care Services, LLC.

• Addiction Medicine (Internal Medicine) Physician in Jackson, TN
• Providers in Jackson, TN by specialty
• Addiction Medicine (Internal Medicine) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.