MEDICARE: BAPTIST NEUROLOGY INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363L00000X	Nurse Practitioner
2	363A00000X	Physician Assistant
3	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1104058874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST NEUROLOGY INC

Provider Business Mailing Address
First Line	:	PO BOX 746649
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6649
Country	:	US
Telephone Number	:	904-202-2092
Fax Number	:	904-376-4075

Provider Business Practice Location Address
First Line	:	1370 13TH AVE S STE 215
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3206
Country	:	US
Telephone Number	:	904-249-1041
Fax Number	:	904-249-9764

Authorized Official
Title or Position	:	MANAGER, CREDENTIALS
Name	:	TYRONE MCCLOUD
Credential	:
Telephone Number	:	904-202-5367

Provider Enumeration Date	:	08/14/2009
Last Update Date	:	04/27/2026

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Directions to “BAPTIST NEUROLOGY INC ” Practice Location

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