Provider Demographics
NPI:1790453454
Name:TAYLORMADE BY TORI T
Entity Type:Organization
Organization Name:TAYLORMADE BY TORI T
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TORIES
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-327-1247
Mailing Address - Street 1:723 PEACHTREE ST E
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-0531
Mailing Address - Country:US
Mailing Address - Phone:912-327-1247
Mailing Address - Fax:
Practice Address - Street 1:723 PEACHTREE ST E
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-0531
Practice Address - Country:US
Practice Address - Phone:912-327-1247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies