Healthcare Provider Details

I. General information

NPI: 1003166851
Provider Name (Legal Business Name): TAYLOR REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 E UNION ST SUITE 101
VIENNA GA
31092-7540
US

IV. Provider business mailing address

PO BOX 1297
HAWKINSVILLE GA
31036-7297
US

V. Phone/Fax

Practice location:
  • Phone: 229-268-1959
  • Fax: 229-268-8323
Mailing address:
  • Phone: 478-783-0200
  • Fax: 478-783-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

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