Healthcare Provider Details

I. General information

NPI: 1982119228
Provider Name (Legal Business Name): FELIX TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4541 N STATE ST
JACKSON MS
39206-5308
US

IV. Provider business mailing address

PO BOX 746085
ATLANTA GA
30374-6085
US

V. Phone/Fax

Practice location:
  • Phone: 601-533-7017
  • Fax: 769-333-9151
Mailing address:
  • Phone: 469-727-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number902294
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: