Individual
SAMUEL TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2000 DAN PROCTOR DR, SAINT MARYS, GA 31558-3810
(912) 576-6200
(919) 477-5474
Mailing address
PO BOX 15133, DURHAM, NC 27704-0133
(919) 477-5152
(919) 477-5474
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004815
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01157773
AMERIGROUP
GA
05
—
762697290B
—
GA
Enumeration date
11/07/2006
Last updated
05/23/2008
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