MEDICARE: BAPTIST OBSTETRICS AND GYNECOLOGY

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
1	207V00000X	Obstetrics & Gynecology 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

General Provider Information

NPI Number	:	1982876827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST OBSTETRICS AND GYNECOLOGY

Provider Business Mailing Address
First Line	:	PO BOX 748867
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8867
Country	:	US
Telephone Number	:	904-202-1032
Fax Number	:	904-376-4107

Provider Business Practice Location Address
First Line	:	3563 PHILIPS HWY STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5627
Country	:	US
Telephone Number	:	904-202-3707
Fax Number	:	904-391-5001

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARSHA DONALDSON
Credential	:
Telephone Number	:	904-376-3707

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	12/08/2022

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Directions to “BAPTIST OBSTETRICS AND GYNECOLOGY ” Practice Location

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