Basic Information
| Provider Information | |||||||||
| NPI: | 1114164787 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | TRAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 53 CENTURY BLVD STE 120 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372143693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153466213 | ||||||||
| FaxNumber: | 6153466225 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 STONECREST PKWY STE 230 | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371676829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152239935 | ||||||||
| FaxNumber: | 6158915046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2009 | ||||||||
| LastUpdateDate: | 09/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 50514 | TN | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD50514 | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | Q023610 | 05 | TN | MEDICAID |