Basic Information
| Provider Information | |||||||||
| NPI: | 1588285126 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAPTIST NEUROLOGY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 41113 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322031113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043764400 | ||||||||
| FaxNumber: | 9043915595 | ||||||||
| Practice Location | |||||||||
| Address1: | 7807 BAYMEADOWS RD E STE 401 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322569668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047303689 | ||||||||
| FaxNumber: | 9047303688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2020 | ||||||||
| LastUpdateDate: | 05/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | KIMBALL | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9042026295 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.