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General NPI Number Information
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NPI Number | 1770940009
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Entity Type | Organization
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Legal Business Name | MHC2 OF TALLAHASSEE
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Dates
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Enumeration Date | 01/18/2016
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Last Update Date | 01/18/2016
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Provider Practice Location Address
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Address Line | 209 OFFICE PLZ
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City | TALLAHASSEE
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State | FL
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Zip | 32301-2807
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Country | US
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Telephone | 850-877-0199
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Fax |
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Provider Business Mailing Address
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Address Line | 209 OFFICE PLZ
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City | TALLAHASSEE
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State | FL
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Zip | 32301-2807
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Country | US
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Telephone | 850-877-0199
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Fax |
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Authorized Official
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Title or Position | BUSINESS DIRECTOR
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Name | SUZANNE HUMPHREY
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Credential | BS
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Telephone | 850-559-3402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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