Provider Demographics
NPI:1407545452
Name:ADJUVA PSYCHIATRY
Entity Type:Organization
Organization Name:ADJUVA PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHTON
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-729-1495
Mailing Address - Street 1:2449 NE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1303
Mailing Address - Country:US
Mailing Address - Phone:954-295-2694
Mailing Address - Fax:
Practice Address - Street 1:2449 NE 13TH AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1303
Practice Address - Country:US
Practice Address - Phone:954-295-2694
Practice Address - Fax:954-724-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty