BRUNDA REVANNA, MD (NPI# 1407943228) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407943228 |
| Entity Type | Organization |
| Organization Name | BRUNDA REVANNA, MD |
| Other Organization Name | JACKSONVILLE FAMILY HEALTH CENTER |
| Practice Address |
1465 A 1st Ave Sw Ste C Jacksonville AL 36265 |
| Mailing Address |
950 Eagles Landing Pkwy #321 Stockbridge GA 30281 |
| Practice Telephone | 6784324755 |
| Mailing Telephone | 6784324755 |
| Mailing Fax Number | 6784324753 |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2008-06-24 |
| Authorized Official Name | DR. BRUNDA REVANNA (PRESIDENT) |
| Authorized Official Telephone | 6784324755 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | 009930945 | 05 |
| Other Name | Type Code |
|---|---|
| JACKSONVILLE FAMILY HEALTH CENTER | Doing Business As Name - Organization |
| Street Address |
1465 A 1ST AVE SW STE C |
| City | JACKSONVILLE |
| State | AL |
| Zip Code | 36265 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700436144 | Griffin Loflin | Specialist/Technologist | 775 Park Ave Nw, Attn. Sports Medicine, Jacksonville, AL 36265 | 2019-09-17 |
| 1114304011 | Caroline Ross | Counselor | 1215 Jackson Way Sw, Jacksonville, AL 36265 | 2015-04-29 |
| 1083001226 | Tracey Hudgins | Counselor | 1215 Jackson's Way, Jacksonville, AL 36265 | 2015-04-24 |
| 1235415118 | Adam Pike | Pharmacist | 311 Pelham Rd So, Jacksonville, AL 36265 | 2011-10-24 |
| 1386829489 | Physicians Choice Dialysis of Jacksonville, LLC | Clinic/Center | 331 Henry Road Sw, Jacksonville, AL 36265 | 2008-01-08 |
| 1659409365 | Kenneth Wayne Campbell | Nurse Anesthetist, Certified Registered | 1701 Pelham Road, Jacksonville Medical Center, Jacksonville, AL 36265 | 2007-03-02 |
| 1154478378 | Diana C. Ford | Counselor | 1250 Jackson's Way, Garrett Counseling Center, Jacksonville, AL 36265 | 2007-01-03 |
| 1487710950 | James Richard Morrison | Chiropractor | 1550 Pelham Rd. S., Jacksonville, AL 36265 | 2006-12-29 |
| 1447332937 | Millennium Anesthesia Services | Anesthesiology | 1701 Pelham Road S, Jacksonville, AL 36265 | 2006-10-20 |
| 1568571602 | Family Practice of Jacksonville PC | Family Medicine | 1881 Hwy 21 South, Jacksonville, AL 36265 | 2006-08-30 |
| Find all providers in zip 36265 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| 1023628351 | Ase Telehealth Inc | Clinic/Center | 5851 Timuquana Rd Ste 104, Jacksonville, FL 32210-7890 | 2020-08-02 |
| 1659840866 | Care4usmd | Clinic/Center | 14866 Old Saint Augustine Rd Ste 113, Jacksonville, FL 32258-2611 | 2018-11-16 |
| 1598278707 | Sunbelt Visiting Primary Care LLC | Clinic/Center | 8833 Perimeter Park Blvd Ste 901, Jacksonville, FL 32216-1113 | 2017-11-09 |
| 1881084390 | Jm Family Enterprises, Inc. | Clinic/Center | 1851 Talleyrand Ave, Jacksonville, FL 32206-5473 | 2015-02-04 |
| 1366790404 | Healthy U Medical Clinic LLC | Clinic/Center | 7208 Highway 238, Jacksonville, OR 97530-9131 | 2012-08-21 |
| 1154696417 | Duc Le Nguyen Md Pa | Clinic/Center | 803 Rosselle St, Jacksonville, FL 32204-2943 | 2012-03-19 |
| 1265704530 | Paul D. Zawatsky, Md, Pa | Clinic/Center | 10609 Old Saint Augustine Rd, Suite 4, Jacksonville, FL 32257-1164 | 2012-02-02 |
| 1619287182 | Down East Family Medicine, Pllc | Clinic/Center | 306 Brynn Marr Road, Jacksonville, NC 28546-7023 | 2010-10-18 |
| 1194033043 | Peoples Medical Centers Primary Care Inc | Clinic/Center | 4114 Sunbeam Rd Ste 102, Jacksonville, FL 32257-8870 | 2010-09-14 |
| 1669797700 | Goshen Medical Center Incorporated | Clinic/Center | 1200 Hargett St, Jacksonville, NC 28540-5933 | 2010-04-01 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 36265 |
Please comment or provide details below to improve the information on BRUNDA REVANNA, MD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.