Healthcare Provider Details

I. General information

NPI: 1437194362
Provider Name (Legal Business Name): AUDIE J TAFF APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 BEAVER OAKS DR
MACON GA
31220-5180
US

IV. Provider business mailing address

1527 BEAVER OAKS DR
MACON GA
31220-5180
US

V. Phone/Fax

Practice location:
  • Phone: 478-474-2470
  • Fax:
Mailing address:
  • Phone: 478-474-2470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number024079
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: