=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104224708
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVER CITY PSYCHIATRY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2014
-----------------------------------------------------
Last Update Date | 12/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 JOHNSTON STREET, SE SUITE 202
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-301-0011
-----------------------------------------------------
Fax | 256-301-0012
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 JOHNSTON STREET, SE SUITE 202
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-301-0011
-----------------------------------------------------
Fax | 256-301-0012
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. M. MERIWETHER BROWN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 256-566-0788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 26199
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------