Provider Demographics
NPI:1265519755
Name:AUSTIN, TAYLOR GENTRY (MD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:GENTRY
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:752 HARTNESS RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3425
Mailing Address - Country:US
Mailing Address - Phone:704-876-5651
Mailing Address - Fax:704-749-5819
Practice Address - Street 1:200 PROVIDENCE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1468
Practice Address - Country:US
Practice Address - Phone:704-749-5800
Practice Address - Fax:704-749-5819
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2006-00791207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC6679BMedicare PIN