Healthcare Provider Details

I. General information

NPI: 1902157514
Provider Name (Legal Business Name): TAYLOR REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E PEACOCK ST
COCHRAN GA
31014-7847
US

IV. Provider business mailing address

PO BOX 1297
HAWKINSVILLE GA
31036-7297
US

V. Phone/Fax

Practice location:
  • Phone: 478-934-0008
  • Fax: 478-934-0500
Mailing address:
  • Phone: 478-783-0200
  • Fax: 478-783-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NIKKI PAULK
Title or Position: COO
Credential:
Phone: 478-783-0200