| NPI | 1295435303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA DAVENPORT Co Owner 931-808-7504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2023-03-07 |