Healthcare Provider Details

I. General information

NPI: 1497182604
Provider Name (Legal Business Name): BAPTIST PRIMARY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 07/07/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 VILLAGE COMMONS DR
ST AUGUSTINE FL
32092
US

IV. Provider business mailing address

PO BOX 746638
ATLANTA GA
30374-6638
US

V. Phone/Fax

Practice location:
  • Phone: 904-940-1441
  • Fax: 904-390-7463
Mailing address:
  • Phone: 904-202-1032
  • Fax: 904-376-4107

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: VICE PRESIDENT
Credential:
Phone: 904-376-3703