Southern Ketamine and Wellness, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

SOUTHERN KETAMINE AND WELLNESS, LLC

Practice address

1932 Laurel Rd Ste 1B
Vestavia Hills, AL 35216-1939

Phone

(205) 202-9163

NPI assigned

Oct 26, 2021

Organization subpart

No

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

Authorized official

Name

John Harrison Irons, MD

Title

Medical Director

Phone

(256) 337-1453

Specialties & licenses 1

Addresses

Electronic endpoints 1

Tax ID family

Southern Ketamine and Wellness LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Southern Ketamine and Wellness, LLC

  • Clinic/Center
  • Opelika, AL
  • NPI 1104611722
  NPD tax ID

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

{
    "created_epoch": "1635206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635206400000",
    "number": "1265196257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1932 LAUREL RD STE 1B",
            "city": "VESTAVIA HILLS",
            "state": "AL",
            "postal_code": "352161939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1932 LAUREL RD STE 1B",
            "city": "VESTAVIA HILLS",
            "state": "AL",
            "postal_code": "352161939",
            "telephone_number": "205-202-9163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN KETAMINE AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-26",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A",
        "authorized_official_last_name": "IRONS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "HARRISON",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "256-337-1453",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "app.ketaminemedia.com",
            "affiliation": "N",
            "address_1": "1932 Laurel Rd Ste 1B",
            "city": "Vestavia Hills",
            "state": "AL",
            "country_code": "US",
            "postal_code": "352161939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Codie Lani Smith, MS, LPC
• Jerri Hendrix Smith, MCD, CCC-SLP
• Julie Smith, PHARMD
• Katy Sarah Smith, OTR/L
• Southern Ketamine and Wellness LLC
• Spark Counseling & Consulting LLC
• Angela Spears, CRNP
• Lauren Sponaugle
• Melanie Hardee Spooner, DMD
• St. Vincent'S Orthopedics, PC

• Clinic/Center in Vestavia Hills, AL
• Providers in Vestavia Hills, AL by specialty
• Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2021; 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.