Healthcare Provider Details

I. General information

NPI: 1801457916
Provider Name (Legal Business Name): JOSHUA W L ATWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 RIVERSIDE AVE
JACKSONVILLE FL
32204-4712
US

IV. Provider business mailing address

3451 RANDALL ST
JACKSONVILLE FL
32205-7817
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-7372
  • Fax: 904-308-2908
Mailing address:
  • Phone: 904-881-7576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME149877
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN29598
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME149877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: