Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME72088 | FL |
N | 207VX0000X | Obstetrician | 033121 | GA |
NPI | 1164412771 |
---|---|
Provider Name | Dr. Thomas K Taylor |
First Address | Fayetteville, GA 30214-5362 |
Second Address | Fayetteville, GA 30214-5362 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 21/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003668200 | (05) | FL |