Provider Demographics
NPI:1164994901
Name:TAYLOR, GWENDOLYN JORDAN (RN)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:JORDAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940-C GA HWY 96
Mailing Address - Street 2:SAME
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088
Mailing Address - Country:US
Mailing Address - Phone:478-988-7100
Mailing Address - Fax:478-988-6847
Practice Address - Street 1:940-C GA HWY 96
Practice Address - Street 2:SAME
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-988-7100
Practice Address - Fax:478-988-6847
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN164195163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)