Provider Demographics
NPI:1780633032
Name:TAYAG, MARIA CRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CRISTINA
Last Name:TAYAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 WATSON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3633
Mailing Address - Country:US
Mailing Address - Phone:478-929-2909
Mailing Address - Fax:478-929-2242
Practice Address - Street 1:1743 WATSON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3633
Practice Address - Country:US
Practice Address - Phone:478-929-2909
Practice Address - Fax:478-929-2242
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000896849EMedicaid
GA11SCDLBMedicare ID - Type Unspecified
GA000896849EMedicaid