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General NPI Number Information
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NPI Number | 1790863744
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC ASSOCIATES
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 03/20/2008
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Provider Practice Location Address
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Address Line | 1160 JOHNSON AVE STE 105
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City | BRIDGEPORT
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State | WV
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Zip | 26330
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Country | US
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Telephone | 304-842-9084
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Fax | 304-842-9085
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Provider Business Mailing Address
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Address Line | 1160 JOHNSON AVE STE 105
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City | BRIDGEPORT
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State | WV
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Zip | 26330
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Country | US
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Telephone | 304-842-9084
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Fax | 304-842-9085
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Authorized Official
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Title or Position | PARTNER
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Name | MR. DAVID FORREST COLVIN
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Credential | MD
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Telephone | 304-842-9084
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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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