Healthcare Provider Details

I. General information

NPI: 1467614651
Provider Name (Legal Business Name): JFK INTERNAL MEDICINE FACULTY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 01/13/2024
Certification Date: 01/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 JFK DR SUITE 102
ATLANTIS FL
33462-6632
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4692
US

V. Phone/Fax

Practice location:
  • Phone: 561-548-6634
  • Fax:
Mailing address:
  • Phone: 615-373-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN CALKINS
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-372-6536