Organization
SOUTHERN ROOTS PSYCHIATRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ETHEL SIZEMORE (OWNER)
(850) 693-4171
Entity
Organization
Contact information
Practice address
4296 5TH AVE, MARIANNA, FL 32446-2173
(850) 693-4171
Mailing address
90 SOUTHERN OAK DR, DOTHAN, AL 36301-7643
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/14/2025
Last updated
05/29/2025
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