Provider Demographics
NPI:1316359383
Name:NORTH FLORIDA REGIONAL PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:NORTH FLORIDA REGIONAL PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TEDRICK
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-3375
Mailing Address - Street 1:2000 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4525
Mailing Address - Country:US
Mailing Address - Phone:615-372-5426
Mailing Address - Fax:866-831-4898
Practice Address - Street 1:1121 NW 64TH TER
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-331-3583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No305S00000XManaged Care OrganizationsPoint of Service
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No333600000XSuppliersPharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50-2560OtherPRECRIPTION DRUGS AND ABUSE: AUGUST 2018
FL21416-17OtherDOMESTIC VIOLENCE
FL50-2560OtherSLEEP DISTERBANCE IN ELDERLY PATIENTS
FL1558829721Medicaid
FL11194-16OtherHIV/AIDS 1 HOUR UPDATE FOR FLORIDA HEALTH PROFESSIONALS