Healthcare Provider Details

I. General information

NPI: 1346554151
Provider Name (Legal Business Name): AFFORDABLE MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5553 HIGHWAY 90
PACE FL
32571-1540
US

IV. Provider business mailing address

PO BOX 628
MILTON FL
32572-0628
US

V. Phone/Fax

Practice location:
  • Phone: 850-995-8811
  • Fax: 850-995-8810
Mailing address:
  • Phone: 850-995-8811
  • Fax: 850-995-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANJU GARG
Title or Position: OWNER
Credential: MD
Phone: 850-995-8811