# ANTIDOTE AI, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023753662
- **Authorized official:** MR. ROY WILLIAM PRILLAMAN III RRT, RN (OPERATIONS)
- **Authorized official phone:** (786) 559-2723

## Contact information

- **Practice address:** 4960 SW 72ND AVE, MIAMI, FL 33155-5544
- **Practice address phone:** (865) 592-7237
- **Mailing address:** 4960 SW 72ND AVE, MIAMI, FL 33155-5544
- **Mailing address phone:** (865) 592-7237

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | NULL | — |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 261QC1500X | Community Health Clinic/Center | — | NULL | Yes |
| 261QC1800X | Corporate Health Clinic/Center | — | NULL | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |
| 333300000X | Emergency Response System Companies | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/28/2022
- **Last updated:** 04/28/2022