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General NPI Number Information
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NPI Number | 1699429027
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Entity Type | Organization
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Legal Business Name | GLADNEY FAMILY MED CENTER LLC
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Dates
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Enumeration Date | 02/04/2022
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 3119 SPRING GLEN RD STE 104
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5921
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Country | US
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Telephone | 470-925-6802
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Fax |
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Provider Business Mailing Address
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Address Line | 61 MARLOW PL
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City | ATLANTA
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State | GA
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Zip | 30328-1640
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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 | OWNER
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Name | RICHO GLADNEY
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Credential |
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Telephone | 470-925-6802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) 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 | 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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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics 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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #5
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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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