Provider Demographics
NPI:1922577428
Name:TAYLOR REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:TAYLOR REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-783-0299
Mailing Address - Street 1:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-7297
Mailing Address - Country:US
Mailing Address - Phone:478-783-0200
Mailing Address - Fax:478-783-3730
Practice Address - Street 1:222 PERRY HWY STE 205
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-6748
Practice Address - Country:US
Practice Address - Phone:478-783-4075
Practice Address - Fax:478-783-3377
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAYLOR REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty