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General NPI Number Information
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NPI Number | 1154615326
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Entity Type | Organization
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Legal Business Name | AJ INITIATIVES, LLC
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 4631 HIGHLANDS PLACE DR
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City | LAKELAND
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State | FL
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Zip | 33813-2160
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Country | US
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Telephone | 863-521-7105
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Fax |
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Provider Business Mailing Address
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Address Line | 4631 HIGHLANDS PLACE DR
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City | LAKELAND
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State | FL
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Zip | 33813-2160
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORDAN ECKERT
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Credential |
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Telephone | 863-521-7105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology 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 | 208600000X
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Taxonomy Name | 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 | 2086S0102X
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Taxonomy Name | Surgical Critical Care 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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | ME72650
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License Number State | FL
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