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General NPI Number Information
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NPI Number | 1679964449
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Entity Type | Organization
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Legal Business Name | AFA PAIN SPECIALISTS, INC
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Dates
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Enumeration Date | 02/13/2015
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Last Update Date | 12/02/2015
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Provider Practice Location Address
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Address Line | 728 BLANDING BLVD SUITE C
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City | ORANGE PARK
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State | FL
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Zip | 32065-7728
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Country | US
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Telephone | 904-639-6747
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Fax | 904-639-6769
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Provider Business Mailing Address
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Address Line | PO BOX 65748
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City | ORANGE PARK
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State | FL
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Zip | 32065-0013
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Country | US
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Telephone | 904-639-6747
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Fax | 904-639-6769
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHARIQ LATIF
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Credential |
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Telephone | 904-654-3918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME113190
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME113190
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License Number State | FL
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