Organization
TAYLOR MADE PEDIATRIC SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER TAYLOR (OWNER)
(706) 499-5489
Entity
Organization
Contact information
Practice address
1688 BEN JONES RD, CLARKESVILLE, GA 30523-3106
(706) 499-5489
Mailing address
PO BOX 143, TURNERVILLE, GA 30580-0143
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT003454
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10036312
AMERIGROUP NUMBER
GA
01
—
306019
WELLCARE NUMBER
GA
Enumeration date
12/04/2006
Last updated
08/22/2020
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