Basic Information
| Provider Information | |||||||||
| NPI: | 1083605349 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMELIA INTERNAL MEDICINE,P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 S 18TH ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | FERNANDINA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320341902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042774690 | ||||||||
| FaxNumber: | 9042778487 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 S 18TH ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | FERNANDINA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320341902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042774690 | ||||||||
| FaxNumber: | 9042778487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 03/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | BURFORD | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9042774690 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.