Provider Demographics
NPI:1184605057
Name:JADA, JOHNNY N (MD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:N
Last Name:JADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17809
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-7809
Mailing Address - Country:US
Mailing Address - Phone:904-723-0015
Mailing Address - Fax:904-723-5665
Practice Address - Street 1:3550 UNIVERSITY BLVD S
Practice Address - Street 2:STE 206
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4246
Practice Address - Country:US
Practice Address - Phone:904-723-0015
Practice Address - Fax:904-723-5665
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52918208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103945OtherAVMED
FL11498OtherHEALTHEASE
FL27285OtherBCBS
FL378546700Medicaid