Healthcare Provider Details

I. General information

NPI: 1336991660
Provider Name (Legal Business Name): MR. MOHAMMED EMAD FAHMI JANAJRAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 10/16/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7485 SW 17TH RD
GAINESVILLE FL
32607
US

IV. Provider business mailing address

1147 NW 64TH TERR
GAINESVILLE FL
32605
US

V. Phone/Fax

Practice location:
  • Phone: 352-339-5980
  • Fax:
Mailing address:
  • Phone: 352-339-5980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: