Provider Demographics
NPI:1225665946
Name:TAYLOR, LARRY LEE JR (NP)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:LEE
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 DONNA AVE
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:GA
Mailing Address - Zip Code:31714-3445
Mailing Address - Country:US
Mailing Address - Phone:229-457-9598
Mailing Address - Fax:
Practice Address - Street 1:1805 TIFT AVE N STE D
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3579
Practice Address - Country:US
Practice Address - Phone:555-422-9382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily