| NPI | 1306107099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA DONALDSON Administrator 904-376-3707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 104100000X Social Worker |
| 207QG0300X Family Medicine, Geriatric Medicine | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2025-07-01 |