MEDICARE: BAPTIST PRIMARY CARE INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363LF0000X	Family Nurse Practitioner
2	363L00000X	Nurse Practitioner
3	208000000X	Pediatrics Physician
4	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	45274	OTHER	FL	BCBS GROUP

General Provider Information

NPI Number	:	1679881536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST PRIMARY CARE INC.

Provider Business Mailing Address
First Line	:	PO BOX 746638
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6638
Country	:	US
Telephone Number	:	904-202-2092
Fax Number	:	904-376-4075

Provider Business Practice Location Address
First Line	:	1210 VINTAGE WAY
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-0299
Country	:	US
Telephone Number	:	904-261-0922
Fax Number	:	904-390-7477

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MARSHA DONALDSON
Credential	:
Telephone Number	:	904-376-3703

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	12/12/2025

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