Provider Demographics
NPI:1326052085
Name:TAYLOR, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 SUTLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4721
Mailing Address - Country:US
Mailing Address - Phone:912-354-6187
Mailing Address - Fax:912-355-9807
Practice Address - Street 1:225 CANDLER DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-354-6187
Practice Address - Fax:912-355-0596
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22960207RH0003X
GA045130207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000942862EMedicaid
GA045130OtherMEDICAL LICENSE
GA000942862AMedicaid
SCG45130Medicaid
GA000942862CMedicaid
GA000942862EMedicaid
GA83BBBRPMedicare PIN
GA000942862AMedicaid
GA000942862CMedicaid