Provider Demographics
NPI:1467468561
Name:TAYLOR, JERTHITIA S (MD)
Entity Type:Individual
Prefix:
First Name:JERTHITIA
Middle Name:S
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2601 BEMISS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1445
Mailing Address - Country:US
Mailing Address - Phone:229-242-6677
Mailing Address - Fax:229-242-1870
Practice Address - Street 1:2601 BEMISS RD
Practice Address - Street 2:SUITE A
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1445
Practice Address - Country:US
Practice Address - Phone:229-242-6677
Practice Address - Fax:229-242-1870
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA057852207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology