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Organization
CLEANSLATE MEDICAL GROUP OF FLORIDA, PLLC
Active
Organization
CLEANSLATE MEDICAL GROUP OF FLORIDA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT HUTCHISON (CFO)
(413) 584-2173
Entity
Organization
Contact information
Practice address
1128 N LAURA ST, JACKSONVILLE, FL 32206-4912
(904) 425-0400
Mailing address
15 CENTURY BLVD STE 307, NASHVILLE, TN 37214-3692
(615) 425-0220
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
NULL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
02/16/2017
Last updated
07/02/2019
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