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General NPI Number Information
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NPI Number | 1710404363
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Entity Type | Organization
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Legal Business Name | CENTER FOR HEALTH AND WELLNESS
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Dates
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Enumeration Date | 08/24/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3117 SPRING GLEN RD STE 407
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5906
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Country | US
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Telephone | 904-476-1816
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Fax | 904-518-5927
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Provider Business Mailing Address
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Address Line | 3117 SPRING GLEN RD STE 407
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5906
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Country | US
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Telephone | 904-476-1816
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Fax | 904-518-5927
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN LAWRENCE SIMONS JR.
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Credential | DO
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Telephone | 904-476-1816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS668100
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License Number State | FL
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