Provider Demographics
NPI:1124538525
Name:JAX PSYCHIATRY LLC
Entity Type:Organization
Organization Name:JAX PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RIAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-834-8042
Mailing Address - Street 1:145 HILDEN RD STE 108
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-8401
Mailing Address - Country:US
Mailing Address - Phone:904-834-1242
Mailing Address - Fax:
Practice Address - Street 1:145 HILDEN RD STE 108
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-8401
Practice Address - Country:US
Practice Address - Phone:904-834-1242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty