Organization
OUTLOOK FORENSIC & BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN KEITH STOUDMIRE M.D. (PRESIDENT)
(704) 841-3886
Entity
Organization
Contact information
Practice address
280 EXECUTIVE PARK DR, SUITE 100, CONCORD, NC 28025-1837
(704) 785-8282
(704) 785-8282
Mailing address
280 EXECUTIVE PARK DR, SUITE 100, CONCORD, NC 28025-1837
(704) 785-8282
(704) 785-8282
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
200500827
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5900927
—
NC
Enumeration date
09/09/2010
Last updated
11/21/2012
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