Provider Demographics
NPI:1083605349
Name:AMELIA INTERNAL MEDICINE,P.A.
Entity Type:Organization
Organization Name:AMELIA INTERNAL MEDICINE,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:BURFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-277-4690
Mailing Address - Street 1:1250 S 18TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1902
Mailing Address - Country:US
Mailing Address - Phone:904-277-4690
Mailing Address - Fax:904-277-8487
Practice Address - Street 1:1250 S 18TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1902
Practice Address - Country:US
Practice Address - Phone:904-277-4690
Practice Address - Fax:904-277-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38983Medicare PIN