Provider Demographics
NPI:1508210485
Name:POLANDER, TAYLOR JORDAN (MD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JORDAN
Last Name:POLANDER
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:PO BOX 1334
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-1334
Mailing Address - Country:US
Mailing Address - Phone:912-427-0800
Mailing Address - Fax:
Practice Address - Street 1:110 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0044
Practice Address - Country:US
Practice Address - Phone:912-427-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0067002207XX0005X
GA93056207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine