| NPI | 1194590018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MARIE HARRIS Owner/Practice Manager 850-215-4060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2023-11-21 |
| Last Update Date | 2023-11-21 |