Provider Demographics
NPI:1790953503
Name:DR. JIM G. TAYLOR, O.D.P.C.
Entity Type:Organization
Organization Name:DR. JIM G. TAYLOR, O.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:CURT
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-642-4434
Mailing Address - Street 1:60 FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4417
Mailing Address - Country:US
Mailing Address - Phone:731-642-4434
Mailing Address - Fax:731-642-4402
Practice Address - Street 1:60 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4417
Practice Address - Country:US
Practice Address - Phone:731-642-4434
Practice Address - Fax:731-642-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN1040152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT78786Medicare UPIN
TN3596469Medicare PIN
TN0403280001Medicare NSC