Basic Information
| Provider Information | |||||||||
| NPI: | 1649452269 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COBBLESTONE PSYCH CTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4204 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358154204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564766691 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1233 WILLOWBROOK DR | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358023834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564766691 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2007 | ||||||||
| LastUpdateDate: | 11/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | HAYES | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2564766691 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | AH2856435 | AL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.