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General NPI Number Information
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NPI Number | 1720264005
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Entity Type | Organization
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Legal Business Name | BLUEGRASS PSYCHIATRY, INC.
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 1000 E LEXINGTON AVE SUITE 26
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City | DANVILLE
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State | KY
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Zip | 40422-9042
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Country | US
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Telephone | 859-236-7756
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Fax | 859-236-7209
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Provider Business Mailing Address
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Address Line | P.O. BOX 763
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City | DANVILLE
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State | KY
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Zip | 40422-1707
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Country | US
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Telephone | 859-236-7756
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Fax | 859-236-7209
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Authorized Official
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Title or Position | OWNER
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Name | MELBORNE WILLIAMS
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Credential | M.D.
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Telephone | 859-236-7756
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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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