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General NPI Number Information
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NPI Number | 1407746969
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Entity Type | Organization
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Legal Business Name | BAPTIST AGEWELL PHYSICIANS INC
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 1545 S 14TH ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-3049
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Country | US
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Telephone | 904-202-4243
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Fax | 904-390-7415
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Provider Business Mailing Address
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Address Line | PO BOX 746636
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City | ATLANTA
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State | GA
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Zip | 30374-6636
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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 | VICE PRESIDENT
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Name | MARSHA DONALDSON
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Credential |
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Telephone | 904-376-3703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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