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Organization
FAMILY PRACTICE OF JACKSONVILLE PC
Active
Organization
FAMILY PRACTICE OF JACKSONVILLE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEWAL K VERMA MD (PRESIDENT)
(256) 435-3035
Entity
Organization
Contact information
Practice address
1881 HWY 21 SOUTH, JACKSONVILLE, AL 36265
(256) 435-3035
(256) 435-9111
Mailing address
PO BOX 777, 1881 HWY 21 SOUTH, JACKSONVILLE, AL 36265
(256) 435-3035
(256) 435-9111
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
7306
AL
207Q00000X
Family Medicine Physician
7306
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01D0689490
CLIA
—
Enumeration date
08/30/2006
Last updated
04/22/2008
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