| NPI | 1578907960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGIA ANN DAVIS Physician/Owner 217-787-9540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084D0003X (Licence: IL 036078693) |
| Additional Taxonomies | 2084P0005X Psychiatry & Neurology, Neurodevelopmental Disabilities (Licence: IL 036078693) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: IL 036078693) | |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2013-04-29 |