Provider Demographics
NPI:1114701513
Name:GEORGE, TAYLOR (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 SERENITY WAY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-1561
Mailing Address - Country:US
Mailing Address - Phone:336-847-9945
Mailing Address - Fax:
Practice Address - Street 1:100 PHYSICIANS WAY STE 110
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-8107
Practice Address - Country:US
Practice Address - Phone:615-547-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2590207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine