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General NPI Number Information
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NPI Number | 1003698184
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Entity Type | Organization
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Legal Business Name | ANAVA EMERGENCY CONSULTANTS LLC
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 159 N 3RD ST
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City | MACCLENNY
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State | FL
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Zip | 32063-2103
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Country | US
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Telephone | 904-259-3151
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Fax |
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Provider Business Mailing Address
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Address Line | 1640 ABERDEEN ST
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City | JACKSONVILLE
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State | FL
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Zip | 32205-8636
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Country | US
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Telephone | 727-515-3119
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GRANT P BARKER
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Credential | MD
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Telephone | 727-515-3119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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