Healthcare Provider Details

I. General information

NPI: 1366880452
Provider Name (Legal Business Name): BAPTIST PRIMARY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 VILLAGE SQUARE PKWY STE 206
FLEMING ISLAND FL
32003-6409
US

IV. Provider business mailing address

1747 BAPTIST CLAY RD SUITE 340
FLEMING ISLAND FL
32003-8501
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-4405
  • Fax: 904-391-5380
Mailing address:
  • Phone: 904-264-4405
  • Fax: 904-391-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARSHA DONALDSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-376-4275