MEDICARE: TAYLOR HALL

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	183500000X	Pharmacist	032505	GA
2	183700000X	Pharmacy Technician
3	183500000X	Pharmacist	0000000000	GA

General Provider Information

NPI Number	:	1780192088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR HALL

Provider Business Mailing Address
First Line	:	500 POOLER PKWY
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322
Country	:	US
Telephone Number	:	912-748-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	5205 ALTA TOWNE LAKE CIR
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-5064
Country	:	US
Telephone Number	:	912-704-8943
Fax Number	:

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

Provider Enumeration Date	:	01/21/2018
Last Update Date	:	11/29/2020

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Directions to “ TAYLOR HALL ” Practice Location

Language	Start Address	Practice Location

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