| NPI | 1801076112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE HICKEY Doctor's Wife 904-242-0422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL me0055724) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2007-11-05 |