Healthcare Provider Details

I. General information

NPI: 1053284976
Provider Name (Legal Business Name): FIRSTHAND MEDICAL OF GEORGIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8384 BAYMEADOWS RD STE 4
JACKSONVILLE FL
32256-7486
US

IV. Provider business mailing address

1032 E BRANDON BLVD STE 4567
BRANDON FL
33511-5509
US

V. Phone/Fax

Practice location:
  • Phone: 201-474-5844
  • Fax: 855-737-3901
Mailing address:
  • Phone: 201-474-5844
  • Fax: 855-737-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA A EMDUR
Title or Position: PRESIDENT
Credential: DO
Phone: 720-684-9159