Healthcare Provider Details

I. General information

NPI: 1992021083
Provider Name (Legal Business Name): ROBERT B TAYLOR JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MEDICAL DR
LAGRANGE GA
30240-4157
US

IV. Provider business mailing address

111 MEDICAL DR
LAGRANGE GA
30240-4157
US

V. Phone/Fax

Practice location:
  • Phone: 706-845-3544
  • Fax: 706-812-2361
Mailing address:
  • Phone: 706-845-3544
  • Fax: 706-812-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number73859
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number073859
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number164985
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number73859
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: