MEDICARE: JAMIE NICOLE TAYLOR CCMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	3322-7849	MS
2	376K00000X	Nurse's Aide	CN0030021696	GA

General Provider Information

NPI Number	:	1700219276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE NICOLE TAYLOR CCMA

Provider Business Mailing Address
First Line	:	5506 EDDIE AVE
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39563-5404
Country	:	US
Telephone Number	:	228-233-8086
Fax Number	:

Provider Business Practice Location Address
First Line	:	5506 EDDIE AVE
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39563-5404
Country	:	US
Telephone Number	:	228-233-8086
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2013
Last Update Date	:	08/19/2013

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