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General NPI Number Information
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NPI Number | 1104078831
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE SURGICAL & MEDICAL AFFILIATES, LLC
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Dates
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Enumeration Date | 10/13/2008
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Last Update Date | 10/13/2008
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Provider Practice Location Address
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Address Line | 1460 2ND AVE SW
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City | JACKSONVILLE
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State | AL
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Zip | 36265-3358
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Country | US
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Telephone | 256-782-4395
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Fax |
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Provider Business Mailing Address
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Address Line | 1460 2ND AVE SW
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City | JACKSONVILLE
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State | AL
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Zip | 36265-3358
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Country | US
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Telephone | 256-782-4395
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | TAMMY COBB
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Credential | CPA
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Telephone | 256-782-4520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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