Healthcare Provider Details

I. General information

NPI: 1033564323
Provider Name (Legal Business Name): TAYLOR REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PERRY HWY BLDG A STE 102
HAWKINSVILLE GA
31036-6748
US

IV. Provider business mailing address

PO BOX 1297
HAWKINSVILLE GA
31036-7297
US

V. Phone/Fax

Practice location:
  • Phone: 478-783-2273
  • Fax: 478-783-2272
Mailing address:
  • Phone: 478-783-9340
  • Fax: 478-783-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: J T MCGINNIS
Title or Position: CFO
Credential:
Phone: 478-783-0262