| NPI | 1508185190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MILLICENT H TANNER Administrator/Owner 904-241-2653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL OS4709) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS4709) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL OS4709) | |
| Enumeration Date | 2010-05-23 |
| Last Update Date | 2013-03-04 |