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General NPI Number Information
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NPI Number | 1194252510
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Entity Type | Organization
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Legal Business Name | BAPTIST CARDIOLOGY INC
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 05/16/2017
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Provider Practice Location Address
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Address Line | 2060 DAN PROCTOR DR STE 3300
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City | SAINT MARYS
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State | GA
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Zip | 31558-3894
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Country | US
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Telephone | 904-224-5189
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 43667
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City | JACKSONVILLE
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State | FL
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Zip | 32203-3667
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Country | US
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Telephone | 904-224-5189
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Fax | 904-725-1622
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARK A MASTERS
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Credential | PHD
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Telephone | 904-425-4557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | GA
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