Provider Demographics
NPI:1710404363
Name:CENTER FOR HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:CENTER FOR HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:904-476-1816
Mailing Address - Street 1:3117 SPRING GLEN RD STE 407
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5906
Mailing Address - Country:US
Mailing Address - Phone:904-476-1816
Mailing Address - Fax:904-518-5927
Practice Address - Street 1:3117 SPRING GLEN RD STE 407
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5906
Practice Address - Country:US
Practice Address - Phone:904-476-1816
Practice Address - Fax:904-518-5927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS668100207Q00000X
207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty