| Brunda Revanna, Md | |
|
1465 A 1st Ave Sw Ste C Jacksonville AL 36265 | |
| (678) 432-4755 | |
| Not Available |
| Full Name | Brunda Revanna, Md |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1465 A 1st Ave Sw Ste C, Jacksonville, Alabama |
| Authorized Official Name and Position | Brunda Revanna (PRESIDENT) |
| Authorized Official Contact | 6784324755 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brunda Revanna, Md 950 Eagles Landing Pkwy #321 Stockbridge GA 30281 Ph: (678) 432-4755 | Brunda Revanna, Md 1465 A 1st Ave Sw Ste C Jacksonville AL 36265 Ph: (678) 432-4755 |
| NPI Number | 1407943228 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 06/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407943228 | NPI | - | NPPES |
| 009930945 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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