Healthcare Provider Details

I. General information

NPI: 1053049098
Provider Name (Legal Business Name): GEORGIA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3888 COUNTY ROAD 210
WATERLOO OH
45688-9343
US

IV. Provider business mailing address

3888 COUNTY ROAD 210
WATERLOO OH
45688-9343
US

V. Phone/Fax

Practice location:
  • Phone: 740-643-0084
  • Fax:
Mailing address:
  • Phone: 740-302-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: