Provider Demographics
NPI:1386163939
Name:FLAGLER PSYCHIATRIC ASSOCIATES
Entity type:Organization
Organization Name:FLAGLER PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:WATKINS
Authorized Official - Last Name:LACY
Authorized Official - Suffix:V
Authorized Official - Credentials:MD
Authorized Official - Phone:904-907-1070
Mailing Address - Street 1:6277 A1A S UNIT 202
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-7515
Mailing Address - Country:US
Mailing Address - Phone:904-907-1070
Mailing Address - Fax:949-660-5868
Practice Address - Street 1:6277 A1A S UNIT 202
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-7515
Practice Address - Country:US
Practice Address - Phone:904-907-1070
Practice Address - Fax:949-660-5868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1283072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty