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General NPI Number Information
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NPI Number | 1114306024
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Entity Type | Organization
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Legal Business Name | BAPTIST ENT SPECIALISTS INC
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 1650 PRUDENTIAL DR STE 200
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8149
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Country | US
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Telephone | 904-202-6082
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Fax | 904-390-7385
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Provider Business Mailing Address
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Address Line | PO BOX 746656
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City | ATLANTA
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State | GA
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Zip | 30374-6656
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Country | US
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Telephone | 904-202-2092
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Fax | 904-376-4075
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CATHERINE HOLLOWAY
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Credential |
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Telephone | 904-202-5378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State | FL
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