Individual
DR. GHASSAN J GHATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13770 BEACH BLVD, SUIT 6, JACKSONVILLE, FL 32224-7205
(904) 330-0524
(904) 647-9491
Mailing address
13770 BEACH BLVD, SUIT 6, JACKSONVILLE, FL 32224-7205
(904) 330-0524
(904) 647-9491
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
ME0026102
FL
208000000X
Pediatrics Physician
Primary
ME0026102
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
099154500
—
FL
Enumeration date
02/28/2006
Last updated
05/13/2021
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