NPI | 1104222801 |
---|---|
Entity Type | Organization |
Authorized Contact | HEATHER EDWARDS Credentialing Coordinator 904-264-6977 |
Organization Subpart ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME112832) |
Enumeration Date | 2014-11-07 |
Last Update Date | 2022-01-28 |