1770838872 NPI number — BEACON PEDIATRIC BEHAVIORAL HEALTH

Table of content: WILLIAM BAXTER PERKINSON JR. DDS (NPI 1831241462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770838872 NPI number — BEACON PEDIATRIC BEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEACON PEDIATRIC BEHAVIORAL HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770838872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6816 SOUTHPOINT PKWY STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-1701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-419-7792
Provider Business Mailing Address Fax Number:
904-900-7732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6816 SOUTHPOINT PKWY STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-419-7792
Provider Business Practice Location Address Fax Number:
904-900-7732
Provider Enumeration Date:
07/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
ADRIENNE
Authorized Official Middle Name:
LEIGH DESANTIS
Authorized Official Title or Position:
MANAGING MEMBER/OWNER/PSYCHOLOGIST
Authorized Official Telephone Number:
904-419-7792

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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