Organization
BRUNDA REVANNA, MD
Active
Other names
JACKSONVILLE FAMILY HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUNDA REVANNA M.D. (PRESIDENT)
(678) 432-4755
Entity
Organization
Contact information
Practice address
1465 A 1ST AVE SW STE C, JACKSONVILLE, AL 36265
(678) 432-4755
Mailing address
950 EAGLES LANDING PKWY #321, STOCKBRIDGE, GA 30281
(678) 432-4755
(678) 432-4753
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009930945
—
AL
Enumeration date
10/05/2006
Last updated
06/24/2008
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