Healthcare Provider Details

I. General information

NPI: 1144285156
Provider Name (Legal Business Name): KENNETH K TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7104 UNIVERSITY CT
MONTGOMERY AL
36117-8045
US

IV. Provider business mailing address

7104 UNIVERSITY CT
MONTGOMERY AL
36117-8045
US

V. Phone/Fax

Practice location:
  • Phone: 334-395-5800
  • Fax: 334-395-5880
Mailing address:
  • Phone: 334-395-5800
  • Fax: 334-395-5880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number00008631
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number8637
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: