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6817 Southpoint Pkwy Suite 2503 Jacksonville FL 32216-6282 | |
| (904) 396-0425 | |
| (904) 396-0448 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 6817 Southpoint Pkwy, Jacksonville, Florida |
| Authorized Official Name and Position | Thomas R. Wikstrom (PSYCHIATRIST/OWNER) |
| Authorized Official Contact | 9043960425 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6817 Southpoint Pkwy Suite 2503 Jacksonville FL 32216-6282 Ph: (904) 396-0425 | 6817 Southpoint Pkwy Suite 2503 Jacksonville FL 32216-6282 Ph: (904) 396-0425 |
| NPI Number | 1356635239 |
|---|---|
| Provider Enumeration Date | 06/08/2011 |
| Last Update Date | 01/27/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356635239 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME52161 (Florida) | Primary |
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