NPIMap

Organization Active NPI

East Tennessee Addiction Specialists

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Maryville, TN
National Provider Identifier
1770080632
Registry record updated Jan 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
EAST TENNESSEE ADDICTION SPECIALISTS
Practice address
111 Station Dr BLDG 3
Maryville, TN 37804-4190
Phone
(865) 268-4360
NPI assigned
Apr 9, 2018
Last updated
Jan 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2026

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

Authorized official

Name
Clay Eugene Stalcup, MDNPI 1750389979
Title
Coowner
Phone
(865) 406-2715

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

111 Station Dr BLDG 3
Maryville, TN 37804-4190

Mailing address

111 Station Dr BLDG 3
Maryville, TN 37804-4190
Phone (865) 268-4360

Other identifiers 1

IdentifierTypeStateIssuer
Q045176MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200203000388 TN Part B Supplier - Clinic/Group Practice 6507292067 Receives reassigned benefits from 10 practitioners
Practice locations: Maryville, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2128542East Tennessee Addiction Specialists, PLLC111 Station Drive, Maryville, TN 37804Certificate of waiverApr 2, 2027
44D2294668East Tennessee Addiction Specialists111 Station Drive, Maryville, TN 37804Certificate of waiverNov 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
East Tennessee Addiction Specialists2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

111 Station Dr
Maryville, TN 37804
Phone (865) 388-2341

111 Station Dr
Bldg 3
Maryville, TN 37804
Phone (865) 268-4360

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1523232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767830400000",
    "number": "1770080632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 STATION DR BLDG 3",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378044190",
            "telephone_number": "865-268-4360",
            "fax_number": "865-329-6507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 STATION DR BLDG 3",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378044190",
            "telephone_number": "865-268-4360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE ADDICTION SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-09",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A",
        "authorized_official_last_name": "STALCUP",
        "authorized_official_first_name": "CLAY",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "COOWNER",
        "authorized_official_telephone_number": "865-406-2715",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q045176",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.