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General NPI Number Information
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NPI Number | 1851719041
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Entity Type | Organization
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Legal Business Name | ATLANTIS LOCUM GROUP, LLC
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 04/03/2014
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Provider Practice Location Address
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Address Line | 15-2218 KANIAU PL.
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City | PAHOA
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State | HI
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Zip | 96778
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Country | US
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Telephone | 808-494-5376
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 511
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City | PAHOA
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State | HI
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Zip | 96778-0511
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Country | US
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Telephone | 808-494-5376
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | MATTHEW M BARRETT
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Credential | MD
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Telephone | 808-494-5376
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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 | MD-17123
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License Number State | HI
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