MEDICARE: CENTER FOR HEALTH AND WELLNESS

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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician
2	207Q00000X	Family Medicine Physician	OS668100	FL

General Provider Information

NPI Number	:	1710404363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	3117 SPRING GLEN RD STE 407
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5906
Country	:	US
Telephone Number	:	904-476-1816
Fax Number	:	904-518-5927

Provider Business Practice Location Address
First Line	:	3117 SPRING GLEN RD STE 407
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5906
Country	:	US
Telephone Number	:	904-476-1816
Fax Number	:	904-518-5927

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN LAWRENCE SIMONS JR.
Credential	:	DO
Telephone Number	:	904-476-1816

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	07/21/2022

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Directions to “CENTER FOR HEALTH AND WELLNESS ” Practice Location

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