Healthcare Provider Details

I. General information

NPI: 1679240337
Provider Name (Legal Business Name): BAPTIST AGEWELL PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 NOCATEE VILLAGE DR
PONTE VEDRA FL
32081-6152
US

IV. Provider business mailing address

PO BOX 746636
ATLANTA GA
30374-6636
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-4243
  • Fax: 904-390-7415
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARSHA DONALDSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 904-202-2141