Healthcare Provider Details

I. General information

NPI: 1497619175
Provider Name (Legal Business Name): JABRIL ABDULLAH
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1274 STATE ST W
JACKSONVILLE FL
32204-1046
US

IV. Provider business mailing address

129 BOYD ST
FOLKSTON GA
31537-4937
US

V. Phone/Fax

Practice location:
  • Phone: 904-537-2287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: