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General NPI Number Information
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NPI Number | 1619140662
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Entity Type | Organization
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Legal Business Name | PALMETTO BEHAVIORAL MEDICINE INC
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 3002 SE 1ST AVE SUITE 100
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City | OCALA
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State | FL
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Zip | 34471-0407
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Country | US
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Telephone | 352-368-2448
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Fax |
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Provider Business Mailing Address
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Address Line | 3002 SE 1ST AVE SUITE 100
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City | OCALA
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State | FL
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Zip | 34471-0407
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Country | US
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Telephone | 352-368-2448
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICAH DENNIS BAXLEY
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Credential | MD
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Telephone | 352-368-2448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | ME100494
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME100494
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License Number State | FL
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