| NPI | 1992181077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLIS FRANKLIN FORT Physician Assistant 386-957-3810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology |
| 225100000X Physical Therapist | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2018-07-16 |