Organization
FLORIDA DEPARTMENT OF HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRIAM GWATHNEY D.O. (MEDICAL DIRECTOR)
(850) 875-7200
Entity
Organization
Contact information
Practice address
278 LASALLE LEFALL DR, QUINCY, FL 32351-5324
(850) 875-7200
(850) 875-7210
Mailing address
278 LASALLE LEFALL DR, QUINCY, FL 32351-5324
(850) 875-7200
(850) 875-7210
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
RN9169219
FL
Other
Enumeration date
01/06/2010
Last updated
01/06/2010
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