MEDICARE: ATLANTIC FAMILY MEDICAL CENTER OF JACKSONVILLE PL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45512	OTHER	FL	BLUE CROSS GROUP NUMBER

General Provider Information

NPI Number	:	1699872812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC FAMILY MEDICAL CENTER OF JACKSONVILLE PL

Provider Business Mailing Address
First Line	:	13155 ATLANTIC BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-3125
Country	:	US
Telephone Number	:	904-221-2222
Fax Number	:	904-221-2024

Provider Business Practice Location Address
First Line	:	13155 ATLANTIC BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-3125
Country	:	US
Telephone Number	:	904-221-2222
Fax Number	:	904-221-2024

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	WILLIAM I SCHWARTZ
Credential	:	D.O.
Telephone Number	:	904-221-2222

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	04/20/2008

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