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General NPI Number Information
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NPI Number | 1033099775
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Entity Type | Organization
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Legal Business Name | AXIS MULTISPECIALTY GROUP PLLC
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 817 NW 56TH TER STE B
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City | GAINESVILLE
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State | FL
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Zip | 32605-6401
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Country | US
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Telephone | 352-234-3050
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Fax | 702-977-1496
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Provider Business Mailing Address
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Address Line | 817 NW 56TH TER STE B
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City | GAINESVILLE
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State | FL
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Zip | 32605-6401
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Country | US
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Telephone | 352-234-3050
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Fax | 702-977-1496
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | KAYLA SHANKS
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Credential |
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Telephone | 725-235-7239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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