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General NPI Number Information
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NPI Number | 1326914045
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Entity Type | Organization
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Legal Business Name | JAX FAMILY HEALTH CLINIC PLLC
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 130 LAND GRANT ST STE 6
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-2262
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Country | US
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Telephone | 904-999-4684
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Fax |
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Provider Business Mailing Address
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Address Line | 130 LAND GRANT ST STE 6
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-2262
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Country | US
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Telephone | 904-999-4684
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SUBHADRA CHEREDDY
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Credential | MD
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Telephone | 612-559-4443
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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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