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General NPI Number Information
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NPI Number | 1689111429
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Entity Type | Organization
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Legal Business Name | BAPTIST HEALTH CLINIC INC
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Dates
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Enumeration Date | 01/31/2017
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Last Update Date | 07/18/2017
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Provider Practice Location Address
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Address Line | 1565 COUNTY ROAD 220
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City | ORANGE PARK
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State | FL
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Zip | 32003-7926
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Country | US
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Telephone | 904-202-5222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40715
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City | JACKSONVILLE
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State | FL
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Zip | 32203-0715
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Country | US
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Telephone | 904-202-5222
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Fax |
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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 | 904-376-3744
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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 | FL
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