MEDICARE: GDMJAX LLC

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
1	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1881553642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GDMJAX LLC

Provider Business Mailing Address
First Line	:	7807 BAYMEADOWS RD E STE 405
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9668
Country	:	US
Telephone Number	:	904-449-7643
Fax Number	:

Provider Business Practice Location Address
First Line	:	7807 BAYMEADOWS RD E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9664
Country	:	US
Telephone Number	:	904-449-7643
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MICHAEL CHANATRY
Credential	:
Telephone Number	:	904-449-7643

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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Directions to “GDMJAX LLC ” Practice Location

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