Provider Demographics
NPI:1013180561
Name:JOHN ASSI, MD, PA
Entity Type:Organization
Organization Name:JOHN ASSI, MD, PA
Other - Org Name:CHILDREN'S HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
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 1:28 W MACCLENNY AVE
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2094
Practice Address - Country:US
Practice Address - Phone:904-259-5766
Practice Address - Fax:904-259-8416
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN ASSI, MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-04
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH45615208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263972604Medicaid