Healthcare Provider Details

I. General information

NPI: 1568453694
Provider Name (Legal Business Name): CHARLES RAYMOND TAYLOR M.A., CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 6TH AVE SE
DECATUR AL
35601-3920
US

IV. Provider business mailing address

3212 TRAILS END SW
DECATUR AL
35603-1277
US

V. Phone/Fax

Practice location:
  • Phone: 256-353-1016
  • Fax: 256-353-1016
Mailing address:
  • Phone: 256-355-9609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number35
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: