| NPI | 1275200784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOUJANYA PULLURU President 904-641-8088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 103T00000X Psychologist |
| 104100000X Social Worker | |
| 231H00000X Audiologist | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2021-12-07 |