Brunda Revanna, MD

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

BRUNDA REVANNA, MD

Doing business as

Jacksonville Family Health Center

Practice address

1465 A 1St Ave SW Ste C
Jacksonville, AL 36265

Phone

(678) 432-4755

NPI assigned

Oct 5, 2006

Last updated

Jun 24, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brunda Revanna, M.D.NPI 1689646135

Title

President

Phone

(678) 432-4755

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• JACKSONVILLE FAMILY HEALTH CENTER Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brunda Revanna, M.D.

  • Family Medicine Physician
  • Birmingham, AL
  • NPI 1689646135
  NPD (past) Authorized official

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1407943228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 EAGLES LANDING PKWY #321",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "30281",
            "telephone_number": "678-432-4755",
            "fax_number": "678-432-4753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 A 1ST AVE SW STE C",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "36265",
            "telephone_number": "678-432-4755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUNDA REVANNA, MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "REVANNA",
        "authorized_official_first_name": "BRUNDA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-432-4755",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009930945",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JACKSONVILLE FAMILY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Arlene R Brown, CRNA
• Frank A Brown, CRNA
• John Oscar Brown, M.D.
• William Benjamin Brown, RPH
• Bruce E. Cunningham, DMD PC
• Amanda Brunner
• Jennifer Savage Burgett, PHD, LAT, ATC
• Calhoun Emergency Group LLC
• Naquisha Calhoun, LPC
• John Micah Calvert

• Primary Care Clinic/Center in Jacksonville, AL
• Providers in Jacksonville, AL by specialty
• Primary Care Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; 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.