Provider Demographics
NPI:1740739358
Name:TAYLOR, GRAHAM (PA-C)
Entity Type:Individual
Prefix:
First Name:GRAHAM
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8435 VANGUARD RD
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31315
Mailing Address - Country:US
Mailing Address - Phone:912-435-9351
Mailing Address - Fax:
Practice Address - Street 1:8435 VANGUARD RD.
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31315
Practice Address - Country:US
Practice Address - Phone:912-435-9351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant