1184671265 NPI number — JOHN L. TAYLOR, JR., M.D., PA

Table of content: (NPI 1184671265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184671265 NPI number — JOHN L. TAYLOR, JR., M.D., PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN L. TAYLOR, JR., M.D., PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184671265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
814 GORDON AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THOMASVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-225-9805
Provider Business Mailing Address Fax Number:
229-225-9915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
814 GORDON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOMASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-225-9805
Provider Business Practice Location Address Fax Number:
229-225-9915
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUMNER
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
229-225-9929

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  015693 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000269882B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9624285 . This is a "SOUTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 21168656803 . This is a "GREAT WEST HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 672327 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 257723363 . This is a "CHAMPUS/TRICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 257723363 . This is a "1ST MEDICAL NETWORK" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 656597 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 9624285 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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