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General NPI Number Information
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NPI Number | 1891359998
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Entity Type | Organization
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Legal Business Name | KIDS AND FAMILIES MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 12086 FORT CAROLINE RD STE 404
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City | JACKSONVILLE
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State | FL
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Zip | 32225-7640
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Country | US
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Telephone | 904-300-6248
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Fax |
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Provider Business Mailing Address
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Address Line | 12086 FORT CAROLINE RD STE 404
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City | JACKSONVILLE
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State | FL
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Zip | 32225-7640
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Country | US
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Telephone | 904-747-3800
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. KIA MITCHELL
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Credential | MD
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Telephone | 904-300-6248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology 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 | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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