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General NPI Number Information
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NPI Number | 1336505395
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Entity Type | Organization
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Legal Business Name | A. GRANT MCDOUGALL, PH.D.
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Dates
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Enumeration Date | 01/06/2016
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Last Update Date | 01/06/2016
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Provider Practice Location Address
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Address Line | 5024 NW 27TH CT STE B
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City | GAINESVILLE
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State | FL
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Zip | 32606-6545
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Country | US
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Telephone | 352-375-4440
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 357504
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City | GAINESVILLE
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State | FL
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Zip | 32635-7504
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Country | US
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Telephone | 352-375-4440
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALFRED GRANT MCDOUGALL
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Credential | PH.D.
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Telephone | 352-375-4440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH5756
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License Number State | FL
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