Basic Information
| Provider Information | |||||||||
| NPI: | 1891905220 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707181122 | ||||||||
| FaxNumber: | 7705357445 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 NE NEFF RD | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977016015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417065911 | ||||||||
| FaxNumber: | 5417062645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 04/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 37868 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 65189 | GA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 065189 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 579046 | 01 | GA | WELLCARE | OTHER | 9589610 | 01 | GA | AETNA | OTHER | 01387925 | 01 | GA | AMERIGROUP | OTHER | 003101445A | 05 | GA | MEDICAID | P00995167 | 01 | GA | MEDICARE RR | OTHER | 003101438A | 05 | GA | MEDICAID | 003101436A | 05 | GA | MEDICAID | 52477131 | 01 | GA | BCBS | OTHER |