Provider Demographics
NPI:1689063505
Name:TAYLOR REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:TAYLOR REGIONAL HOSPITAL
Other - Org Name:TAYLOR PHYSICIANS PRACTICE # 26
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:N
Authorized Official - Last Name:PAULK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-783-0200
Mailing Address - Street 1:222 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-6748
Mailing Address - Country:US
Mailing Address - Phone:478-783-0200
Mailing Address - Fax:
Practice Address - Street 1:150 E PEACOCK ST
Practice Address - Street 2:STE B
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-7847
Practice Address - Country:US
Practice Address - Phone:478-934-6926
Practice Address - Fax:478-934-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty