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NPI Code Detail

MEDICARE: GENTA MEDICAL CLINIC P.C.

MEDICARE: GENTA MEDICAL CLINIC P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist15032AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115032OTHERCALICENSE NUMBER

General Provider Information

NPI Number : 1073612339
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENTA MEDICAL CLINIC P.C.
Provider Business Mailing Address
First Line : 1460 1ST AVE SW
Second Line :
City : JACKSONVILLE
State : AL
Zip : 36265-3329
Country : US
Telephone Number : 256-435-2895
Fax Number : 256-435-2969
Provider Business Practice Location Address
First Line : 1460 1ST AVE SW
Second Line :
City : JACKSONVILLE
State : AL
Zip : 36265-3329
Country : US
Telephone Number : 256-435-2895
Fax Number : 256-435-2969
Authorized Official
Title or Position : PRESIDENT
Name : DR. JOHN OSCAR BROWN
Credential : M.D.
Telephone Number : 256-435-2895
Provider Enumeration Date : 09/22/2006
Last Update Date : 11/19/2008

Similar Medicare Providers

1023077781 — JOHN OSCAR BROWN M.D.
Practice Location Address:
1460 1ST AVE SW
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36265-3329
Practice Phone: 256-435-2895
Practice Fax: 256-435-2969
1215950753 — DR. BRUCE EDWARD CUNNINGHAM DMD
Practice Location Address:
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Practice Phone: 256-435-2007
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1417449349 — DR. DAKOTA B CLARK DMD
Practice Location Address:
1450 1ST AVE SW
JACKSONVILLE, AL
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Practice Fax: 256-435-4669
1982173084 — BRUCE E. CUNNINGHAM, DMD PC
Practice Location Address:
1450 1ST AVE SW
JACKSONVILLE, AL
36265-3329
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Practice Fax:
1972101426 — DAKOTA B CLARK DMD LLC
Practice Location Address:
1450 1ST AVE SW
JACKSONVILLE, AL
36265-3329
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Practice Fax:
1154645240 — MS. NATONIA SHERIE DAVIS LCSW, MBA
Practice Location Address:
5663 GREENLAND RD
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32258-3329
Practice Phone: 904-302-9355
Practice Fax: 844-528-1420

Directions to “GENTA MEDICAL CLINIC P.C. ” Practice Location

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