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General NPI Number Information
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NPI Number | 1902597008
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Entity Type | Organization
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Legal Business Name | SUMMIT PSYCHIATRY LLC
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Dates
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Enumeration Date | 05/18/2023
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 1 PERIMETER PARK S STE 486N
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City | BIRMINGHAM
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State | AL
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Zip | 35243-3239
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Country | US
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Telephone | 205-807-9343
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 DOUG BAKER BLVD STE 107-190
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City | HOOVER
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State | AL
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Zip | 35242-4974
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Country | US
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Telephone | 205-410-5123
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BENNY WINK
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Credential |
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Telephone | 205-410-5123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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