DR. BRUNDA REVANNA


Address: 1465a 1st Ave Sw Ste A, Jacksonville, AL 36265
Phone: 2564358383

DR. BRUNDA REVANNA (NPI# 1689646135) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1689646135
Entity Type Individual
Full Name DR. BRUNDA REVANNA
Credential M.D.
Practice Address 1465a 1st Ave Sw Ste A
Jacksonville
AL 36265
Mailing Address 950 Eagles Landing Pwky #321
Stockbridge
GA 30281
Practice Telephone 2564358383
Mailing Telephone 6784324755
Mailing Fax Number 6784324753
Enumeration Date 2006-02-07
Last Update Date 2015-06-15
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207Q00000X Family Medicine 00025426 AL Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
TRICARE 270060909 01
AL BCBS 051517109 01
AL 009930945 05

Office Location

Street Address 1465A 1ST AVE SW STE A
City JACKSONVILLE
State AL
Zip Code 36265

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1700436144 Griffin Loflin Specialist/Technologist 775 Park Ave Nw, Attn. Sports Medicine, Jacksonville, AL 36265 2019-09-17
1114304011 Caroline Ross Counselor 1215 Jackson Way Sw, Jacksonville, AL 36265 2015-04-29
1083001226 Tracey Hudgins Counselor 1215 Jackson's Way, Jacksonville, AL 36265 2015-04-24
1235415118 Adam Pike Pharmacist 311 Pelham Rd So, Jacksonville, AL 36265 2011-10-24
1386829489 Physicians Choice Dialysis of Jacksonville, LLC Clinic/Center 331 Henry Road Sw, Jacksonville, AL 36265 2008-01-08
1659409365 Kenneth Wayne Campbell Nurse Anesthetist, Certified Registered 1701 Pelham Road, Jacksonville Medical Center, Jacksonville, AL 36265 2007-03-02
1154478378 Diana C. Ford Counselor 1250 Jackson's Way, Garrett Counseling Center, Jacksonville, AL 36265 2007-01-03
1487710950 James Richard Morrison Chiropractor 1550 Pelham Rd. S., Jacksonville, AL 36265 2006-12-29
1447332937 Millennium Anesthesia Services Anesthesiology 1701 Pelham Road S, Jacksonville, AL 36265 2006-10-20
1407943228 Brunda Revanna, Md Clinic/Center 1465 A 1st Ave Sw Ste C, Jacksonville, AL 36265 2006-10-05
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Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]
- Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.
- Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1528676186 Sarah Colleen Tapscott Family Medicine 1908 Mill Creek Rd, Jacksonville, FL 32211-5052 2020-07-20
1790303170 Samantha L Scott Family Medicine 516 Pierce Ln, Jacksonville, TX 75766-4546 2020-07-11
1689298689 Meridian Spine and Joint, Inc Family Medicine 9770 Old Baymeadows Rd Ste 139, Jacksonville, FL 32256-7986 2020-06-04
1154942563 Families First Medical Group Family Medicine 12086 Fort Caroline Rd Ste 103, Jacksonville, FL 32225-2688 2020-04-27
1598396392 Pareto Population Health Management Practice Pllc Family Medicine 1697 Kings Rd Ste 1, Jacksonville, FL 32209-6169 2020-01-30
1942862206 Cindy S Wright Do Pllc Family Medicine 12627 San Jose Blvd Ste 902, Jacksonville, FL 32223-8645 2019-07-07
1942868377 Pain Spine & Wellness LLC Family Medicine 9770 Old Baymeadows Rd Ste 141, Jacksonville, FL 32256-7986 2019-05-31
1669035705 Kathy Jo Daniels Family Medicine 10457 Wellington Springs Way, Jacksonville, FL 32221-1175 2019-04-15
1821579103 Tiffany N Major Family Medicine 5194 Johnson Creek Dr, Jacksonville, FL 32218-9308 2018-08-24
1568987360 Main Street Health LLC Family Medicine 2 Shircliff Way Ste 620, Jacksonville, FL 32204-4762 2017-08-14
Find all providers in JACKSONVILLE

Competitor

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City JACKSONVILLE
Zip Code 36265

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Dataset Information

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.

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