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General NPI Number Information
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NPI Number | 1114675030
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Entity Type | Individual
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Provider Name | TAYLOR LOUISE BARGELOH PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 2321 POOLER PKWY STE 107
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City | POOLER
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State | GA
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Zip | 31322-4423
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Country | US
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Telephone | 912-303-7149
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Fax |
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Provider Business Mailing Address
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Address Line | 434 STONEBRIDGE CIR
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City | SAVANNAH
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State | GA
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Zip | 31419-9854
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Country | US
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Telephone | 309-262-0899
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 11721
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License Number State | GA
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