Provider Demographics
NPI:1649274291
Name:TAICH, ARTHUR S (FNP)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:S
Last Name:TAICH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:ARCHIE
Other - Middle Name:
Other - Last Name:TAICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:79 HOLDER RD
Mailing Address - Street 2:
Mailing Address - City:LUMPKIN
Mailing Address - State:GA
Mailing Address - Zip Code:31815
Mailing Address - Country:US
Mailing Address - Phone:662-838-2163
Mailing Address - Fax:662-838-7944
Practice Address - Street 1:79 HOLDER RD
Practice Address - Street 2:
Practice Address - City:LUMPKIN
Practice Address - State:GA
Practice Address - Zip Code:31815
Practice Address - Country:US
Practice Address - Phone:229-838-1252
Practice Address - Fax:229-838-1242
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2951862363LF0000X
NMR44069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03733868Medicaid
MS500001659Medicare ID - Type Unspecified
Q29683Medicare UPIN