Provider Demographics
NPI:1982882775
Name:G CLAY TAYLOR
Entity Type:Organization
Organization Name:G CLAY TAYLOR
Other - Org Name:ANKLE & FOOT CENTERS OF GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:GIOVINCO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:678-561-9000
Mailing Address - Street 1:1975 HIGHWAY 54 W
Mailing Address - Street 2:STE 205
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4794
Mailing Address - Country:US
Mailing Address - Phone:678-561-9000
Mailing Address - Fax:678-854-1977
Practice Address - Street 1:1975 HIGHWAY 54 W
Practice Address - Street 2:STE 205
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4794
Practice Address - Country:US
Practice Address - Phone:678-561-9000
Practice Address - Fax:678-854-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00640332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000494491DMedicaid
GAU33331Medicare UPIN
GA000494491DMedicaid
GA48SCBVZMedicare PIN