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Organization

CRG34AH01 LLC

Active
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Organization

CRG34AH01 LLC

Active
Other names
Medicus Spine & Joint
Organization subpart
No

Provider details

NPI number
Authorized official
LOGAN MORRIS (MANAGER)
(904) 503-1065
Entity
Organization

Contact information

Practice address
4540 SOUTHSIDE BLVD STE 202, JACKSONVILLE, FL 32216-5488
(904) 503-1065
(904) 374-6075
Mailing address
4540 SOUTHSIDE BLVD STE 202, JACKSONVILLE, FL 32216-5488
(904) 503-1065
(904) 374-6075

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
207XS0117X
Orthopaedic Surgery of the Spine Physician
207XX0801X
Orthopaedic Trauma Physician
2084P0301X
Brain Injury Medicine (Psychiatry & Neurology) Physician
208VP0014X
Interventional Pain Medicine Physician
Primary
363L00000X
Nurse Practitioner

Other

Enumeration date
04/02/2024
Last updated
04/02/2024
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