Provider Demographics
NPI:1205049301
Name:KERRY TAYLOR INC
Entity type:Organization
Organization Name:KERRY TAYLOR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:336-723-7707
Mailing Address - Street 1:3623 LATROBE DR
Mailing Address - Street 2:SUITE 227
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4864
Mailing Address - Country:US
Mailing Address - Phone:704-365-4982
Mailing Address - Fax:704-365-4983
Practice Address - Street 1:3623 LATROBE DR
Practice Address - Street 2:SUITE 227
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4864
Practice Address - Country:US
Practice Address - Phone:704-365-4982
Practice Address - Fax:704-365-4983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization