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General NPI Number Information
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NPI Number | 1346419058
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Entity Type | Organization
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Legal Business Name | LAWRENCE & CHONA WYLIE,M.D.,P.A
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 150 S BEACH ST STE A
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City | ORMOND BEACH
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State | FL
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Zip | 32174
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Country | US
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Telephone | 386-672-2100
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Fax | 386-672-2135
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Provider Business Mailing Address
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Address Line | 150 S BEACH ST STE A
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City | ORMOND BEACH
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State | FL
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Zip | 32174
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Country | US
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Telephone | 386-672-2100
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Fax | 386-672-2135
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHONA DEGRACIA WYLIE
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Credential | M.D
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Telephone | 386-672-2100
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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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