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General NPI Number Information
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NPI Number | 1386163939
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Entity Type | Organization
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Legal Business Name | FLAGLER PSYCHIATRIC ASSOCIATES
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6277 A1A S UNIT 202
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-7515
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Country | US
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Telephone | 904-907-1070
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Fax | 949-660-5868
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Provider Business Mailing Address
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Address Line | 6277 A1A S UNIT 202
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-7515
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Country | US
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Telephone | 904-907-1070
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Fax | 949-660-5868
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENJAMIN WATKINS LACY V
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Credential | MD
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Telephone | 904-907-1070
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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 | ME128307
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License Number State | FL
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