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General NPI Number Information
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NPI Number | 1881708733
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE HEALTH CLINIC PA
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2030 SOUTHSIDE BOULEVARD SUITE C
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City | JACKSONVILLE
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State | FL
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Zip | 32216
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Country | US
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Telephone | 904-726-1797
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Fax | 904-726-1798
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Provider Business Mailing Address
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Address Line | P O BOX 16486
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City | JACKSONVILLE
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State | FL
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Zip | 32246-6486
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Country | US
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Telephone | 904-726-1797
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Fax | 904-726-1798
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Authorized Official
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Title or Position | OWNER
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Name | DR. SOUJANYA SANGAM
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Credential | MD
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Telephone | 904-726-1797
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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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