Provider Demographics
NPI:1053049098
Name:TAYLOR, GEORGIA
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3888 COUNTY ROAD 210
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:OH
Mailing Address - Zip Code:45688-9343
Mailing Address - Country:US
Mailing Address - Phone:740-302-5666
Mailing Address - Fax:
Practice Address - Street 1:3888 COUNTY ROAD 210
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:OH
Practice Address - Zip Code:45688-9343
Practice Address - Country:US
Practice Address - Phone:740-643-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program