Organization
PONTE VEDRA PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN SPOONER MD (PRESIDENT)
(904) 280-6701
Entity
Organization
Contact information
Practice address
230 CANAL BLVD STE 2, PONTE VEDRA BEACH, FL 32082-3745
(904) 280-6701
(904) 280-6702
Mailing address
230 CANAL BLVD STE 2, PONTE VEDRA BEACH, FL 32082-3745
(904) 280-6701
(904) 280-6702
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
Other
Enumeration date
01/27/2023
Last updated
01/27/2023
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