| NPI | 1538703038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT ERIC BALOGH Owner 901-305-6789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2019-10-29 |