Basic Information
| Provider Information | |||||||||
| NPI: | 1407311152 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERRYMAN | ||||||||
| FirstName: | MARISOL | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 69 LINDSEY LN STE B | ||||||||
| Address2: | |||||||||
| City: | SAINT MARYS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315581702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122668686 | ||||||||
| FaxNumber: | 8667642841 | ||||||||
| Practice Location | |||||||||
| Address1: | 6817 SOUTHPOINT PKWY STE 1501 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322166298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505210242 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2019 | ||||||||
| LastUpdateDate: | 02/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.