Provider Demographics
NPI:1114134780
Name:TAYLOR, JONATHAN HARRIS (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:HARRIS
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 1:1850 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-413-6678
Mailing Address - Fax:252-215-2905
Practice Address - Street 1:1850 W ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-413-6678
Practice Address - Fax:252-215-2905
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200700626208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200756OtherMEDCOST
NC7011767OtherCIGNA
NC5907568Medicaid
NC14559OtherBLUE CROSS
NC200756OtherMEDCOST