Faith Wellness Center LLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

FAITH WELLNESS CENTER LLC

Practice address

5298 Sunbeam Rd Ste 8
Jacksonville, FL 32257-6292

Phone

(904) 621-0748

Fax

(904) 212-5810

NPI assigned

Feb 4, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Chantina Davis, PHYSICIAN ASSISTANT

Title

Owner

Phone

(904) 621-0748

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643932800000",
    "number": "1053065540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13836 GABRIEL CT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322247213",
            "telephone_number": "904-333-5980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5298 SUNBEAM RD STE 8",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322576292",
            "telephone_number": "904-621-0748",
            "fax_number": "904-212-5810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAITH WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-04",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CHANTINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-621-0748",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PHYSICIAN ASSISTANT"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.