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General NPI Number Information
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NPI Number | 1689011710
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Entity Type | Organization
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Legal Business Name | BAPTIST UROLOGY, INC.
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1348 S 18TH ST STE 210
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4785
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Country | US
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Telephone | 904-277-2003
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Fax | 904-376-3271
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Provider Business Mailing Address
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Address Line | PO BOX 746643
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City | ATLANTA
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State | GA
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Zip | 30374-6643
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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 | ADMINISTRATOR
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Name | MASHA DONALDSON
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Credential |
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Telephone | 904-376-3707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State | FL
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