Provider Demographics
NPI:1326914045
Name:JAX FAMILY HEALTH CLINIC PLLC
Entity type:Organization
Organization Name:JAX FAMILY HEALTH CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUBHADRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-559-4443
Mailing Address - Street 1:130 LAND GRANT ST STE 6
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2262
Mailing Address - Country:US
Mailing Address - Phone:904-999-4684
Mailing Address - Fax:
Practice Address - Street 1:130 LAND GRANT ST STE 6
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-2262
Practice Address - Country:US
Practice Address - Phone:904-999-4684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty