Provider Demographics
NPI:1376111096
Name:JACKSONVILLE PSYCHIATRY AND WELLNESS LLC
Entity Type:Organization
Organization Name:JACKSONVILLE PSYCHIATRY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BIH
Authorized Official - Middle Name:B
Authorized Official - Last Name:TAMBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-760-7562
Mailing Address - Street 1:3101 UNIVERSITY BLVD S STE 206
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2753
Mailing Address - Country:US
Mailing Address - Phone:904-886-0361
Mailing Address - Fax:904-886-0382
Practice Address - Street 1:3101 UNIVERSITY BLVD S STE 206
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2753
Practice Address - Country:US
Practice Address - Phone:904-886-0361
Practice Address - Fax:904-886-0382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty