Southern Ketamine And Wellness, LLC
Clinic/Center in Vestavia Hills, AL. Organization (NPI-2).
NPI number1265196257
StatusActive
Last updated in NPPESOct 26, 2021
Details
- NPI
- 1265196257
- Entity type
- Organization (NPI-2)
- Legal business name
- Southern Ketamine And Wellness, LLC
- Organization subpart
- No
- Enumeration date
- Oct 26, 2021
- Certification date
- Oct 26, 2021
- Last updated
- Oct 26, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
Practice location
1932 Laurel Rd Ste 1bVestavia Hills, AL 35216-1939
Phone 205-202-9163
Mailing address
1932 Laurel Rd Ste 1bVestavia Hills, AL 35216-1939
Authorized official
John Harrison Irons
Medical Director
2563371453
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