| Ponte Vedra Psychiatry Llc | |
|
230 Canal Blvd Ste 2 Ponte Vedra Beach FL 32082-3745 | |
| (904) 280-6701 | |
| (904) 280-6702 |
| Full Name | Ponte Vedra Psychiatry Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
| Location | 230 Canal Blvd Ste 2, Ponte Vedra Beach, Florida |
| Authorized Official Name and Position | Justin Spooner (PRESIDENT) |
| Authorized Official Contact | 9042806701 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ponte Vedra Psychiatry Llc 230 Canal Blvd Ste 2 Ponte Vedra Beach FL 32082-3745 Ph: (904) 280-6701 | Ponte Vedra Psychiatry Llc 230 Canal Blvd Ste 2 Ponte Vedra Beach FL 32082-3745 Ph: (904) 280-6701 |
| NPI Number | 1366158883 |
|---|---|
| Provider Enumeration Date | 01/27/2023 |
| Last Update Date | 01/27/2023 |
| Certification Date | 01/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366158883 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
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