Organization
JACKSONVILLE INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REY GAVINO (OWNER)
(256) 343-1800
Entity
Organization
Contact information
Practice address
430 GEORGE WALLACE DR # 246, GADSDEN, AL 35903-2280
(256) 343-1800
(256) 365-1046
Mailing address
PO BOX 550, JACKSONVILLE, AL 36265-0550
(256) 343-1800
(256) 365-1046
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25404
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01D1017203
CLIA
AL
Enumeration date
10/31/2006
Last updated
07/27/2023
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