Healthcare Provider Details

I. General information

NPI: 1659299170
Provider Name (Legal Business Name): GUIDEWELL MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2733
US

IV. Provider business mailing address

4800 DEERWOOD CAMPUS PKWY
JACKSONVILLE FL
32246-6498
US

V. Phone/Fax

Practice location:
  • Phone: 386-676-7100
  • Fax:
Mailing address:
  • Phone: 386-676-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACY WILLIAMS
Title or Position: CEO
Credential:
Phone: 386-676-7100