Organization
TABATHA TAYLOR
Active
Other names
Holly Medical Supply Company
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TABATHA TAYLOR (OWNER)
(478) 456-6713
Entity
Organization
Contact information
Practice address
3006 GRAY HWY, MACON, GA 31211-6684
(478) 752-3660
(478) 752-3622
Mailing address
3006 GRAY HWY, MACON, GA 31211-6684
(478) 752-3660
(478) 752-3622
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013929050A
—
GA
01
—
51000005
BLUE CROSS & BLUE SHIELD
GA
Enumeration date
03/15/2007
Last updated
09/15/2009
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