DR. AVANELLE V JACK (NPI# 1316996671) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316996671 |
| Entity Type | Individual |
| Full Name | DR. AVANELLE V JACK |
| Other Name | DR. AVANELLE V JACK-JACKSON |
| Credential | MD |
| Practice Address |
208 Scranton Connector Ste 117 Brunswick GA 31525-0560 |
| Mailing Address |
208 Scranton Connector Suite 117 Brunswick GA 31525 |
| Practice Telephone | 9122645961 |
| Practice Fax Number | 9122629499 |
| Mailing Telephone | 9122645961 |
| Mailing Fax Number | 9122629499 |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2017-10-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
78666 | GA | Allopathic & Osteopathic Physicians |
| N | 207RN0300X |
Internal Medicine Specialization: Nephrology |
MD.022645 | LA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1491501 | 05 |
| Street Address |
208 SCRANTON CONNECTOR STE 117 |
| City | BRUNSWICK |
| State | GA |
| Zip Code | 31525-0560 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437795408 | Krysta Hartley | Physician Assistant | 208 Scranton Connector Ste 117, Brunswick, GA 31525-0560 | 2019-11-25 |
| 1023571411 | Brunswick Urgent Care, LLC | Nurse Practitioner | 208 Scranton Connector Ste 117, Brunswick, GA 31525-0560 | 2019-04-11 |
| 1013468883 | Kacey Miller | Physician Assistant | 208 Scranton Connector Ste 117, Brunswick, GA 31525-0560 | 2016-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063905990 | Jonathon Wesley Capps | Physician Assistant | 1111 Glynco Pkwy Bldg 1, Ste 10, Brunswick, GA 31525 | 2018-06-14 |
| 1366993628 | Hands Down Muscle Restoration, Inc | Homeopath | 1212 Chapel Crossing Road, Brunswick, GA 31525 | 2016-10-20 |
| 1619424173 | Jebediah S Christy Dds - Brunswick Pllc | Dentist | 11455 Canal Crossing, Brunswick, GA 31525 | 2016-09-01 |
| 1831545508 | Heller Family Medicine, LLC | General Practice | 208 Scranton Connector Ste 120, Brunswick, GA 31525 | 2016-05-11 |
| 1437525391 | Natisha Danielle Hill | Occupational Therapy Assistant | 138 Wingefield Commons Drive, Brunswick, GA 31525 | 2015-08-14 |
| 1811269632 | Solar Family Practice | Family Medicine | 122 Scranton Connector, Suite 112, Brunswick, GA 31525 | 2012-02-09 |
| 1700187895 | Chetan Patel | Pharmacist | 12 Woodfall Ct, Brunswick, GA 31525 | 2010-11-05 |
| 1194914275 | Dialysis of Golden Isles, LLC | Clinic/Center | 475 Gateway Center Blvd, Brunswick, GA 31525 | 2007-10-15 |
| 1902939325 | Gateway Behavioral Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 111 Frazier Street, Brunswick, GA 31525 | 2007-03-14 |
| 1609909498 | Gateway Behavioral Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 115 Frazier Road, Brunswick, GA 31525 | 2007-03-13 |
| Find all providers in zip 31525 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649296682 | Bryan James Krull | Internal Medicine | 3025 Shrine Rd Ste 450, Brunswick, GA 31520 | 2006-07-14 |
| 1861456378 | Ahmed Elsharkawi | Internal Medicine | 3025 Shrine Rd Ste 270, Brunswick, GA 31520-4785 | 2006-04-12 |
| 1487628277 | Paul Allen Bowen II | Internal Medicine | 208 Scranton Connector, Suite 117, Brunswick, GA 31525-0559 | 2006-02-16 |
| 1356879902 | Nephrology and Hypertension Medical Associates PC | Internal Medicine | 3025 Shrine Rd, Brunswick, GA 31520-4784 | 2017-05-26 |
| 1215305305 | Ahmed Elsharkawi, Md LLC | Internal Medicine | 2500 Starling St, Suite 601, Brunswick, GA 31520-4265 | 2015-09-08 |
| 1770978900 | Jose Salvador Reyes Oliva | Internal Medicine | 3025 Shrine Rd Ste 270, Brunswick, GA 31520-4785 | 2015-04-03 |
| 1225439748 | Amy Raj Patel | Internal Medicine | 3025 Shrine Rd Ste 270, Brunswick, GA 31520-4785 | 2014-09-16 |
| 1902230006 | Rafael David Rodriguez Abreu | Internal Medicine | 3025 Shrine Rd Ste 450, Brunswick, GA 31520-4787 | 2013-08-26 |
| 1881981777 | Reejis Stephen | Internal Medicine | 3025 Shrine Rd Ste 270, Brunswick, GA 31520-4785 | 2011-06-30 |
| 1184856494 | Ahmed Elsharkawi Md LLC | Internal Medicine | 390 Eh Ct, Brunswick, GA 31520-2198 | 2009-08-20 |
| Find all providers in BRUNSWICK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.