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General NPI Number Information
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NPI Number | 1992828818
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Entity Type | Organization
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Legal Business Name | PENSACOLA PRIMARY CARE INC
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Dates
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Enumeration Date | 04/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5942 BERRYHILL RD
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City | MILTON
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State | FL
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Zip | 32570-4009
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Country | US
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Telephone | 850-981-9340
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Fax | 850-626-7882
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Provider Business Mailing Address
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Address Line | 5942 BERRYHILL RD
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City | MILTON
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State | FL
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Zip | 32570-4009
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Country | US
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Telephone | 850-981-9340
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Fax | 850-626-7882
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Authorized Official
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Title or Position | VP
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Name | MICKEY PICKLER
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Credential |
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Telephone | 850-523-2117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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