| NPI | 1821393380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN PAUL CONNELL Managing Member 229-382-7898 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: GA NTP001047) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: GA NTP001047) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: GA PHOP000045) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: GA NTP001047) | |
| Enumeration Date | 2011-01-14 |
| Last Update Date | 2011-01-14 |