Healthcare Provider Details

I. General information

NPI: 1831390616
Provider Name (Legal Business Name): SOUTHERN BAPTIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BEACH BLVD SUITE 930
JACKSONVILLE BEACH FL
32250-4368
US

IV. Provider business mailing address

4160 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4317
US

V. Phone/Fax

Practice location:
  • Phone: 904-376-3800
  • Fax: 904-733-9598
Mailing address:
  • Phone: 904-376-3800
  • Fax: 904-733-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. ELLEN WILLIAMS
Title or Position: DIRECTOR
Credential: PHD
Phone: 904-376-3800