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General NPI Number Information
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NPI Number | 1255532024
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Entity Type | Organization
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Legal Business Name | SOUTHERN BAPTIST HOSPITAL
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1325 SAN MARCO BLVD SUITE 500
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8568
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Country | US
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Telephone | 904-376-3800
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Fax | 904-733-9598
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Provider Business Mailing Address
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Address Line | 4160 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4317
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Country | US
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Telephone | 904-376-3800
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Fax | 904-733-9598
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ELLEN WILLIAMS
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Credential | PHD
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Telephone | 904-376-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | FL
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