Organization
MENTAL SOUTH WELLNESS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN CARVAJAL M.D (PHYSICIAN)
(904) 494-8277
Entity
Organization
Contact information
Practice address
125 EDGEWATER BRANCH DR, SAINT JOHNS, FL 32259-4417
(904) 494-8277
Mailing address
125 EDGEWATER BRANCH DR, SAINT JOHNS, FL 32259-4417
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
02/09/2016
Last updated
02/09/2016
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