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General NPI Number Information
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NPI Number | 1184862708
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Entity Type | Organization
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Legal Business Name | PRECISE PSYCHOPHARMACOLOGY LLC
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 3531 LAKELAND DR SUITE 1060
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City | FLOWOOD
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State | MS
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Zip | 39232-8049
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Country | US
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Telephone | 601-420-5810
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Fax | 601-420-5811
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Provider Business Mailing Address
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Address Line | 3531 LAKELAND DR SUITE 1060
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City | FLOWOOD
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State | MS
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Zip | 39232-8049
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Country | US
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Telephone | 601-420-5810
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Fax | 601-420-5811
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH A KWENTUS
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Credential | M.D.
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Telephone | 601-420-5810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 17834
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License Number State | MS
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