Basic Information
| Provider Information | |||||||||
| NPI: | 1649274291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAICH | ||||||||
| FirstName: | ARTHUR | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TAICH | ||||||||
| OtherFirstName: | ARCHIE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 79 HOLDER RD | ||||||||
| Address2: | |||||||||
| City: | LUMPKIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6628382163 | ||||||||
| FaxNumber: | 6628387944 | ||||||||
| Practice Location | |||||||||
| Address1: | 79 HOLDER RD | ||||||||
| Address2: | |||||||||
| City: | LUMPKIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2298381252 | ||||||||
| FaxNumber: | 2298381242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| LastUpdateDate: | 07/02/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP2951862 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | R44069 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 03733868 | 05 | MS | MEDICAID |