MEDICARE: SOUTHERN BAPTIST HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	101YM0800X	Mental Health Counselor	FL
2	2084P0800X	Psychiatry Physician	FL
3	103TC1900X	Counseling Psychologist	FL

General Provider Information

NPI Number	:	1831390616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN BAPTIST HOSPITAL

Provider Business Mailing Address
First Line	:	4160 UNIVERSITY BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4317
Country	:	US
Telephone Number	:	904-376-3800
Fax Number	:	904-733-9598

Provider Business Practice Location Address
First Line	:	900 BEACH BLVD
Second Line	:	SUITE 930
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4368
Country	:	US
Telephone Number	:	904-376-3800
Fax Number	:	904-733-9598

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ELLEN WILLIAMS
Credential	:	PHD
Telephone Number	:	904-376-3800

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	09/11/2025

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Directions to “SOUTHERN BAPTIST HOSPITAL ” Practice Location

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