| NPI | 1285809012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANAN MOORE Practice Manager 904-808-8595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS7389) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2022-09-21 |