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General NPI Number Information
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NPI Number | 1962256909
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Entity Type | Organization
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Legal Business Name | HOMECALL MD LLC
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Dates
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Enumeration Date | 04/16/2024
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 700 3RD ST STE 202
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City | NEPTUNE BEACH
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State | FL
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Zip | 32266-5082
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Country | US
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Telephone | 904-635-6081
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 ATLANTIC BLVD # 214
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-3313
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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 | PRESIDENT
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Name | ANYA JOHNSON
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Credential | SLP
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Telephone | 904-635-6081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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