Provider Demographics
NPI:1912447038
Name:TAYLOR PHYSICIANS CLINIC
Entity Type:Organization
Organization Name:TAYLOR PHYSICIANS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-783-0329
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 1:911 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6785
Practice Address - Country:US
Practice Address - Phone:478-559-1064
Practice Address - Fax:478-934-0500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAYLOR REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty