| NPI | 1891359998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIA MITCHELL Authorized Official 904-300-6248 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine |
| Additional Taxonomies | 2080P0205X Pediatrics, Pediatric Endocrinology |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2020-06-09 |