Provider Demographics
NPI:1326413246
Name:FAMILY HEALTH ASSOCIATES OF KINGS ROAD
Entity Type:Organization
Organization Name:FAMILY HEALTH ASSOCIATES OF KINGS ROAD
Other - Org Name:FAMILY HEALTH ASSOCIATES OF KINGS ROAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-398-1471
Mailing Address - Street 1:3710 GRANDY AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-6112
Mailing Address - Country:US
Mailing Address - Phone:904-398-1471
Mailing Address - Fax:904-398-1460
Practice Address - Street 1:1697 KINGS RD
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6169
Practice Address - Country:US
Practice Address - Phone:904-524-8344
Practice Address - Fax:904-551-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty