Provider Demographics
NPI:1417335464
Name:HARRIS, CYNTHIA TAYLOR
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:TAYLOR
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:SURGICAL
Other - Last Name:SERVICES. PC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4445 OLD DIXIE HWY S
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-3316
Mailing Address - Country:US
Mailing Address - Phone:912-272-8492
Mailing Address - Fax:
Practice Address - Street 1:4445 OLD DIXIE HWY S
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329-3316
Practice Address - Country:US
Practice Address - Phone:912-272-8492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN168703163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant