| 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 |