Healthcare Provider Details

I. General information

NPI: 1902605660
Provider Name (Legal Business Name): ATLANTIC COAST CARDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8245 BAYBERRY RD
JACKSONVILLE FL
32256-7432
US

IV. Provider business mailing address

8245 BAYBERRY RD
JACKSONVILLE FL
32256-7432
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-7775
  • Fax: 904-296-7760
Mailing address:
  • Phone: 904-296-7775
  • Fax: 904-296-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ABDUL R KANI
Title or Position: MD /OWNER
Credential: MD
Phone: 904-296-7775