Provider Demographics
NPI:1528396058
Name:DUNN AVENUE HEALTH AND WELLNESS CENTER INC
Entity Type:Organization
Organization Name:DUNN AVENUE HEALTH AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:904-329-1904
Mailing Address - Street 1:3450 DUNN AVE
Mailing Address - Street 2:STE. 302
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-6426
Mailing Address - Country:US
Mailing Address - Phone:904-329-1904
Mailing Address - Fax:904-329-1905
Practice Address - Street 1:3450 DUNN AVE
Practice Address - Street 2:STE. 302
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6426
Practice Address - Country:US
Practice Address - Phone:904-329-1904
Practice Address - Fax:904-329-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 6019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45366300Medicaid
FL80135Medicare PIN
E68470Medicare UPIN