Ammala Cantrell

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME84833 Issued in FL

Legal business name

AMMALA CANTRELL

Doing business as

CANTRELL MEDICAL CLINIC

Practice address

1370 13TH Ave S
Suite 216a
Jacksonville Beach, FL 32250-3230

Phone

(904) 372-0208

Fax

(904) 853-6559

NPI assigned

Nov 7, 2007

Organization subpart

No

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

Authorized official

Name

Ammala Cantrell, MD

Title

President

Phone

(904) 673-5553

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CANTRELL MEDICAL CLINIC Doing business as

Locations

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350000000000",
    "number": "1699955617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50670",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322400670",
            "telephone_number": "904-372-0208",
            "fax_number": "904-853-6559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 13TH AVE S",
            "address_2": "SUITE 216A",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503230",
            "telephone_number": "904-372-0208",
            "fax_number": "904-853-6559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMMALA CANTRELL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-07",
        "last_updated": "2012-10-12",
        "status": "A",
        "authorized_official_last_name": "CANTRELL",
        "authorized_official_first_name": "AMMALA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-673-5553",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME84833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF FLORIDA",
            "identifier": "K8204",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CANTRELL MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; 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.