MEDICARE: TAYLOR REGIONAL HOSPITAL

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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1568711380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAYLOR REGIONAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 1297
Second Line	:
City	:	HAWKINSVILLE
State	:	GA
Zip	:	31036-7297
Country	:	US
Telephone Number	:	478-783-0200
Fax Number	:	478-783-2731

Provider Business Practice Location Address
First Line	:	1012 GA HIGHWAY 247 S STE 101
Second Line	:
City	:	KATHLEEN
State	:	GA
Zip	:	31047-2349
Country	:	US
Telephone Number	:	478-931-0776
Fax Number	:	478-934-0779

Authorized Official
Title or Position	:	COO
Name	:	NIKKI PAULK
Credential	:
Telephone Number	:	478-783-0200

Provider Enumeration Date	:	09/07/2012
Last Update Date	:	03/29/2022

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Directions to “TAYLOR REGIONAL HOSPITAL ” Practice Location

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