Provider Demographics
NPI:1437194362
Name:TAFF, AUDIE J (APRN-BC)
Entity Type:Individual
Prefix:
First Name:AUDIE
Middle Name:J
Last Name:TAFF
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 BEAVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-5180
Mailing Address - Country:US
Mailing Address - Phone:478-474-2470
Mailing Address - Fax:
Practice Address - Street 1:1527 BEAVER OAKS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220-5180
Practice Address - Country:US
Practice Address - Phone:478-474-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024079364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA83-02555OtherEVERCARE
GA83-02555OtherEVERCARE