Provider Demographics
NPI:1164928768
Name:TAYLOR, WILLIAM JACKSON
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JACKSON
Last Name:TAYLOR
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 1:2700 CHARLOTTE AVE APT 400
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4095
Mailing Address - Country:US
Mailing Address - Phone:678-488-2052
Mailing Address - Fax:
Practice Address - Street 1:5655 FRIST BLVD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2053
Practice Address - Country:US
Practice Address - Phone:615-316-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA98832207P00000X
390200000X
TN63535207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program