Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | ME0026102 | FL |
Y | 208000000X | Pediatrician | ME0026102 | FL |
NPI | 1013983063 |
---|---|
Provider Name | Dr. Ghassan J Ghata |
First Address | Jacksonville, FL 32224-7205 |
Second Address | Jacksonville, FL 32224-7205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 13/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
099154500 | (05) | FL |
D52569 | (02) | FL |