Provider Demographics
NPI:1508280512
Name:BRUNSON, CHRISTOPHER (CAP 5938)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:BRUNSON
Suffix:
Gender:M
Credentials:CAP 5938
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 SOUTHPOINT DR N
Mailing Address - Street 2:NORTH FLORIDA/SOUTH GEORGIA VA SPECIALTY CLINIC
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8007
Mailing Address - Country:US
Mailing Address - Phone:904-470-6900
Mailing Address - Fax:904-739-0170
Practice Address - Street 1:6900 SOUTHPOINT DR N
Practice Address - Street 2:NORTH FLORIDA/SOUTH GEORGIA VA SPECIALTY CLINIC
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8007
Practice Address - Country:US
Practice Address - Phone:904-470-6900
Practice Address - Fax:904-739-0170
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5938101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCAP 5938OtherCERTIFIED ADDICTIONS PROFESSIONAL