Provider Demographics
NPI:1053830653
Name:HALL, TAYLOR JON
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JON
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 W BRITT DAVID RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4509
Mailing Address - Country:US
Mailing Address - Phone:607-972-5894
Mailing Address - Fax:
Practice Address - Street 1:197TH BDE 1-46 BN
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:31909
Practice Address - Country:US
Practice Address - Phone:706-545-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0058052255A2300X
NY0026732255A2300X
GAAT0041382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer