Healthcare Provider Details

I. General information

NPI: 1124460530
Provider Name (Legal Business Name): JDG CIRCLE INPATIENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18167 US HIGHWAY 19 N SUITE #650
CLEARWATER FL
33764-3528
US

IV. Provider business mailing address

3651 WHEELER RD
AUGUSTA GA
30909-6521
US

V. Phone/Fax

Practice location:
  • Phone: 727-437-0818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY J. BYRNE
Title or Position: PRESIDENT/MD
Credential:
Phone: 954-838-2371