| NPI | 1104058874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRONE MCCLOUD Manager, Credentials 904-202-5367 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2009-08-14 |
| Last Update Date | 2026-04-27 |