Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 033213 | GA |
NPI | 1083619670 |
---|---|
Provider Name | Dr. William Dennis Taylor |
First Address | Dublin, GA 31021-0356 |
Second Address | Dublin, GA 31021-0356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 19/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000443748C | (05) | GA |
E81474 | (02) | GA |