MEDICARE: MR. RICHARD LEE TAYLOR M.ED

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	101Y00000X	Counselor	LDC0000000490	TN
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	0987T	GA
3	101YP2500X	Professional Counselor	2241	GA

General Provider Information

NPI Number	:	1841327574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD LEE TAYLOR M.ED

Provider Business Mailing Address
First Line	:	700 CITY HALL DR
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-7802
Country	:	US
Telephone Number	:	706-861-3387
Fax Number	:	706-638-5541

Provider Business Practice Location Address
First Line	:	700 CITY HALL DR
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-7802
Country	:	US
Telephone Number	:	706-861-3387
Fax Number	:	706-638-5541

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	09/26/2008

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