Basic Information
| Provider Information | |||||||||
| NPI: | 1689252843 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEALY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2808 SAINT LEONARD DR | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323123038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506941391 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2152 OLD SPRINGVILLE RD | ||||||||
| Address2: | |||||||||
| City: | CENTER POINT | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352154005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058386000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2021 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.