Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1003474628 |
---|---|
Provider Name | Walter Taylor |
First Address | Columbus, GA 31903-2727 |
Second Address | Columbus, GA 31903-2727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2019 |
Last Update Date | 29/05/2019 |