# AMMALA CANTRELL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CANTRELL MEDICAL CLINIC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699955617
- **Authorized official:** AMMALA CANTRELL MD (PRESIDENT)
- **Authorized official phone:** (904) 673-5553

## Contact information

- **Practice address:** 1370 13TH AVE S, SUITE 216A, JACKSONVILLE BEACH, FL 32250-3230
- **Practice address phone:** (904) 372-0208
- **Practice address fax:** (904) 853-6559
- **Mailing address:** PO BOX 50670, JACKSONVILLE BEACH, FL 32240-0670
- **Mailing address phone:** (904) 372-0208
- **Mailing address fax:** (904) 853-6559

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | ME84833 | FL | Yes |

## Other

- **Enumeration date:** 11/07/2007
- **Last updated:** 10/12/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | K8204 | BC/BS OF FLORIDA | FL |