Organization
GENESIS FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY C CHANMUGAM D.O (OWNER)
(386) 218-2353
Entity
Organization
Contact information
Practice address
800 S NOVA RD, SUITE I, ORMOND BEACH, FL 32174-9048
(386) 676-9300
(386) 676-9050
Mailing address
1133 SAXON BLVD, STE 200, ORANGE CITY, FL 32763-8425
(386) 218-2353
(386) 228-9701
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
OS8600
FL
Other
Enumeration date
02/14/2017
Last updated
11/28/2022
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