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General NPI Number Information
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NPI Number | 1114356680
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Entity Type | Organization
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Legal Business Name | CLINICITY
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 1357 TOM STILL RD
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City | TALLAHASSEE
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State | FL
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Zip | 32305-7541
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Country | US
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Telephone | 850-251-5688
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Fax |
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Provider Business Mailing Address
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Address Line | 1357 TOM STILL RD
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City | TALLAHASSEE
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State | FL
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Zip | 32305-7541
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Country | US
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Telephone | 850-251-5688
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. WYATT IRVIN HENDRICKS
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Credential |
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Telephone | 850-251-5688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | ME28955
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License Number State | FL
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