Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Mental Health |
101YM0800X | |||
Psychiatry |
2084P0800X | 26 | Physician/Psychiatry |
| NPI # | 1811524085 |
| LBN Legal business name | 22KILL |
| Authorized official | TEMPA SHERRILL - (COO) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 03/26/2020 |
| Last updated | 03/26/2020 - About 6 years ago |
| Identifiers | n/a |
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