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General NPI Number Information
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NPI Number | 1912720871
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Entity Type | Organization
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Legal Business Name | TAYLOR MADE IV ENTERPRISES INC
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 13781 PULASKI PIKE
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City | ARDMORE
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State | AL
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Zip | 35739-9520
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Country | US
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Telephone | 256-337-0177
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Fax |
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Provider Business Mailing Address
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Address Line | 13781 PULASKI PIKE
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City | ARDMORE
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State | AL
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Zip | 35739-9520
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Country | US
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Telephone | 256-337-0177
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MALCOLM TAYLOR III
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Credential |
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Telephone | 256-337-0177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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