Basic Information
| Provider Information | |||||||||
| NPI: | 1932378213 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4605 MACCORKLE AVENUE, SW | ||||||||
| Address2: | THS PHYSICIAN PARTNERS, INC.-ADMIN OFC | ||||||||
| City: | SOUTH CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044144800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 MACCORKLE AVE SE, STE B16 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043885848 | ||||||||
| FaxNumber: | 3043889654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2008 | ||||||||
| LastUpdateDate: | 10/31/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 01311 | WV | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 1311 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.