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NPI Code Detail

MEDICARE: BAPTIST NEUROLOGY INC

MEDICARE: BAPTIST NEUROLOGY 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
1363A00000XPhysician Assistant
2363L00000XNurse Practitioner
32084N0400XNeurology Physician

General Provider Information

NPI Number : 1124956958
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 118
Second Line :
City : JACKSONVILLE BEACH
State : FL
Zip : 32250-3206
Country : US
Telephone Number : 904-398-5407
Fax Number : 904-391-5779
Authorized Official
Title or Position : MANAGER, CREDENTIALS
Name : TYRONE MCCLOUD
Credential :
Telephone Number : 904-202-5367
Provider Enumeration Date : 05/12/2026
Last Update Date : 05/12/2026

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Directions to “BAPTIST NEUROLOGY INC ” Practice Location

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