Provider Demographics
NPI:1184862708
Name:PRECISE PSYCHOPHARMACOLOGY LLC
Entity Type:Organization
Organization Name:PRECISE PSYCHOPHARMACOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KWENTUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-420-5810
Mailing Address - Street 1:3531 LAKELAND DR
Mailing Address - Street 2:SUITE 1060
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8049
Mailing Address - Country:US
Mailing Address - Phone:601-420-5810
Mailing Address - Fax:601-420-5811
Practice Address - Street 1:3531 LAKELAND DR
Practice Address - Street 2:SUITE 1060
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8049
Practice Address - Country:US
Practice Address - Phone:601-420-5810
Practice Address - Fax:601-420-5811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS178342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02523719Medicaid
MSC03274Medicare PIN