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General NPI Number Information
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NPI Number | 1679011969
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE INTERNAL MEDICINE AND WELLNESS, LLC
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 1323 HAMRIC DR E STE A
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City | OXFORD
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State | AL
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Zip | 36203-1917
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Country | US
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Telephone | 256-365-2416
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Fax | 256-365-2426
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Provider Business Mailing Address
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Address Line | 1323 HAMRIC DR E STE A
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City | OXFORD
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State | AL
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Zip | 36203-1917
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Country | US
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Telephone | 256-365-2416
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Fax | 256-365-2426
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDUARDO J VILLEDA
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Credential | MD
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Telephone | 917-684-7325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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