MEDICARE: DR. TAYLOR EMERICK FORNS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	62168	KY
2	207ZC0006X	Clinical Pathology Physician	62168	KY

General Provider Information

NPI Number	:	1306370473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAYLOR EMERICK FORNS MD

Provider Business Mailing Address
First Line	:	515 S MANGUM ST APT 5542
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27701-4385
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4402 CHURCHMAN AVE STE 306
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-3101
Country	:	US
Telephone Number	:	502-852-0132
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	06/16/2026

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