MEDICARE: BAPTIST PRIMARY CARE INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1881961126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST PRIMARY CARE INC

Provider Business Mailing Address
First Line	:	PO BOX 746638
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6638
Country	:	US
Telephone Number	:	904-202-1032
Fax Number	:	904-376-4107

Provider Business Practice Location Address
First Line	:	2310 VILLAGE SQUARE PKWY STE 106
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-6409
Country	:	US
Telephone Number	:	904-264-6404
Fax Number	:	904-390-7455

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MARSHA DONALDSON
Credential	:
Telephone Number	:	904-376-3703

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	11/08/2023

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