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NPI Code Detail

MEDICARE: BAPTIST AGEWELL PHYSICIANS INC

MEDICARE: BAPTIST AGEWELL PHYSICIANS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QG0300XGeriatric Medicine (Family Medicine) PhysicianFL

General Provider Information

NPI Number : 1023595105
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAPTIST AGEWELL PHYSICIANS INC
Provider Business Mailing Address
First Line : PO BOX 746636
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6636
Country : US
Telephone Number : 904-202-2092
Fax Number : 904-376-4075
Provider Business Practice Location Address
First Line : 1325 SAN MARCO BLVD STE 300
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8567
Country : US
Telephone Number : 904-202-4243
Fax Number : 904-390-7415
Authorized Official
Title or Position : VICE PRESIDENT
Name : ELIZABETH TIBBS
Credential :
Telephone Number : 904-202-3283
Provider Enumeration Date : 07/23/2018
Last Update Date : 03/03/2026

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Directions to “BAPTIST AGEWELL PHYSICIANS INC ” Practice Location

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