Organization
SOUTHSIDE FAMILY PRACTICE &WOMENS HEALTH PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUPARNA GULANI M.D (MEDICAL DIRECTOR)
(904) 296-1010
Entity
Organization
Contact information
Practice address
8075 GATE PKWY W, SUITE 102&103, JACKSONVILLE, FL 32216-3684
(904) 296-1010
(904) 296-0393
Mailing address
8075 GATE PKWY W, SUITE 102&103, JACKSONVILLE, FL 32216-3684
(904) 296-1010
(904) 296-0393
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME83942
FL
Other
Enumeration date
03/13/2007
Last updated
12/04/2012
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