Healthcare Provider Details

I. General information

NPI: 1194644989
Provider Name (Legal Business Name): JMJ CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4689 US HIGHWAY 17 STE 11-12
FLEMING ISLAND FL
32003-4831
US

IV. Provider business mailing address

4689 US HIGHWAY 17 STE 11-12
FLEMING ISLAND FL
32003-4831
US

V. Phone/Fax

Practice location:
  • Phone: 806-773-0678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON PHILLIPS
Title or Position: OWNER
Credential: MD
Phone: 806-773-0678