Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 85944 | GA |
NPI | 1144502436 |
---|---|
Provider Name | Mr. Taylor Wright Mclendon |
First Address | Macon, GA 31210-1365 |
Second Address | Macon, GA 31207-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2011 |
Last Update Date | 25/06/2020 |