Mental South Wellness PA

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

MENTAL SOUTH WELLNESS PA

Practice address

125 Edgewater Branch Dr
Saint Johns, FL 32259-4417

Phone

(904) 494-8277

NPI assigned

Feb 9, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jonathan Carvajal, M.D

Title

Physician

Phone

(904) 494-8277

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454976000000",
    "number": "1255799896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 EDGEWATER BRANCH DR",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322594417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 EDGEWATER BRANCH DR",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322594417",
            "telephone_number": "904-494-8277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL SOUTH WELLNESS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-09",
        "last_updated": "2016-02-09",
        "status": "A",
        "authorized_official_last_name": "CARVAJAL",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "904-494-8277",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Saint Johns, FL
• Providers in Saint Johns, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.