| NPI | 1780240754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM NIELDS Md/Owner 904-923-3484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2019-06-13 |