MEDICARE: PRACTICE MANAGEMENT ASSOCIATES JACKSONVILLE

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	207QA0401X	Addiction Medicine (Family Medicine) Physician		FL

General Provider Information

NPI Number	:	1942691035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRACTICE MANAGEMENT ASSOCIATES JACKSONVILLE

Provider Business Mailing Address
First Line	:	7999 PHILIPS HWY
Second Line	:	UNIT 305
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7999 PHILIPS HWY
Second Line	:	UNIT 305
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4443
Country	:	US
Telephone Number	:	904-503-9646
Fax Number	:

Authorized Official
Title or Position	:	MANAGING OFFICER
Name	:	MR. CHRISTOPHER BRANCH
Credential	:
Telephone Number	:	904-503-9646

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	02/10/2015

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