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General NPI Number Information
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NPI Number | 1295149854
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Entity Type | Organization
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Legal Business Name | PEACEFUL MIND PSYCHIATRY, LLC
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 4635 NW 53RD AVE STE 205
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City | GAINESVILLE
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State | FL
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Zip | 32653-3418
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Country | US
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Telephone | 352-672-6339
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Fax | 833-876-3634
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Provider Business Mailing Address
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Address Line | 4707 NW 71ST PL
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City | GAINESVILLE
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State | FL
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Zip | 32653-1155
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JING LIU
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Credential |
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Telephone | 352-219-1624
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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 |
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License Number State |
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