Provider Demographics
NPI:1184671265
Name:JOHN L. TAYLOR, JR., M.D., PA
Entity Type:Organization
Organization Name:JOHN L. TAYLOR, JR., M.D., PA
Other - Org Name:PLANTATION GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUMNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-225-9929
Mailing Address - Street 1:814 GORDON AVENUE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792
Mailing Address - Country:US
Mailing Address - Phone:229-225-9805
Mailing Address - Fax:229-225-9915
Practice Address - Street 1:814 GORDON AVENUE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792
Practice Address - Country:US
Practice Address - Phone:229-225-9805
Practice Address - Fax:229-225-9915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN L. TAYLOR, JR., M.D., PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-27
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015693207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000269882BMedicaid
GA9624285OtherSOUTHCARE
GA21168656803OtherGREAT WEST HEALTHCARE
GA672327OtherBCBS
GA257723363OtherCHAMPUS/TRICARE
GA257723363Other1ST MEDICAL NETWORK
GA656597OtherUNITED HEALTHCARE
GA9624285OtherCIGNA
GA000269882BMedicaid
GA21168656803OtherGREAT WEST HEALTHCARE
GA160046613Medicare ID - Type UnspecifiedRAILROAD MEDICARE
GAGRP7732Medicare PIN
GA21168656803OtherGREAT WEST HEALTHCARE