Organization
CANTRELL CORNERSTONE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMMALA CANTRELL MD (OWNER)
(904) 673-5553
Entity
Organization
Contact information
Practice address
11512 LAKE MEAD AVE UNIT 302, JACKSONVILLE, FL 32256-9685
(904) 900-3472
(904) 503-2373
Mailing address
11512 LAKE MEAD AVE UNIT 302, JACKSONVILLE, FL 32256-9685
(904) 900-3472
(904) 503-2373
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME84833
FL
Other
Enumeration date
09/27/2017
Last updated
07/21/2022
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