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General NPI Number Information
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NPI Number | 1588173967
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Entity Type | Organization
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Legal Business Name | WOODLANDS ADDICTION MEDICINE GROUP
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 2610 TECHNOLOGY FOREST BLVD
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City | THE WOODLANDS
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State | TX
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Zip | 77381-3904
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Country | US
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Telephone | 954-691-0856
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Fax | 954-691-0834
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Provider Business Mailing Address
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Address Line | 1100 PARK CENTRAL BLVD S STE 3400
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City | POMPANO BEACH
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State | FL
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Zip | 33064-2265
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Country | US
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Telephone | 954-691-0856
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Fax | 954-691-0834
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Authorized Official
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Title or Position | CEO
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Name | MISS JAMIE STEVENS
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Credential |
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Telephone | 904-495-0223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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