Provider Demographics
NPI:1104025063
Name:TAYLOR, DONALD PAUL (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:PAUL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CAISSON XING
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-1302
Mailing Address - Country:US
Mailing Address - Phone:912-434-4662
Mailing Address - Fax:
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-3849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230342207P00000X
GA059518207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG59518Medicaid
GA879220139AMedicaid
GA01062414OtherAMERIGROUP
GA407212OtherWELLCARE
GA879220139AOtherPEACHSTATE HEALTH PLAN