Provider Demographics
NPI:1447595293
Name:AJD MEDICAL INC
Entity Type:Organization
Organization Name:AJD MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DECARLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-427-0390
Mailing Address - Street 1:501 LIVE OAK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7312
Mailing Address - Country:US
Mailing Address - Phone:386-427-0390
Mailing Address - Fax:386-427-0394
Practice Address - Street 1:501 LIVE OAK ST
Practice Address - Street 2:SUITE B
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7312
Practice Address - Country:US
Practice Address - Phone:386-427-0390
Practice Address - Fax:386-427-0394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL82935207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty