| NPI | 1124788146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAYLE BLACKMER Executive Director 904-202-4104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2021-12-20 |