Provider Demographics
NPI:1841327574
Name:TAYLOR, RICHARD LEE (MED)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CITY HALL DR
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-7802
Mailing Address - Country:US
Mailing Address - Phone:706-861-3387
Mailing Address - Fax:706-638-5541
Practice Address - Street 1:700 CITY HALL DR
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-7802
Practice Address - Country:US
Practice Address - Phone:706-861-3387
Practice Address - Fax:706-638-5541
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000000490101Y00000X
GA0987T101YA0400X
GA2241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional