Provider Demographics
NPI:1760596670
Name:TAYLOR, MAXIE JAMES II (RPH)
Entity Type:Individual
Prefix:MR
First Name:MAXIE
Middle Name:JAMES
Last Name:TAYLOR
Suffix:II
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 TURKEY TROT DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY FACE
Mailing Address - State:GA
Mailing Address - Zip Code:30740-8534
Mailing Address - Country:US
Mailing Address - Phone:706-277-3272
Mailing Address - Fax:
Practice Address - Street 1:1042 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2081
Practice Address - Country:US
Practice Address - Phone:706-629-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13889183500000X
TN7280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist