Provider Demographics
NPI:1487622825
Name:TAYLOR, ALICE R (NP)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 ALICE ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4525
Mailing Address - Country:US
Mailing Address - Phone:912-284-9800
Mailing Address - Fax:912-284-1711
Practice Address - Street 1:1218 ALICE ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4525
Practice Address - Country:US
Practice Address - Phone:912-284-9800
Practice Address - Fax:912-284-1711
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR0045223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA824339259AMedicaid
GA824339259AMedicaid
GA50BBHFBMedicare ID - Type UnspecifiedMEDICARE