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General NPI Number Information
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NPI Number | 1447139829
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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 | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 3563 PHILIPS HWY BLDG B
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5663
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Country | US
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Telephone | 904-202-2557
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Fax | 904-393-2958
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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 | 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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