Individual
DERRICK W TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 NORMAN DORMINY DR, SUITE B, FITZGERALD, GA 31750
(229) 423-2058
(229) 423-0197
Mailing address
PO BOX 929, 110 NORMAN DORMINY DR SUITE B, FITZGERALD, GA 31750
(229) 423-2058
(229) 423-0197
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
053043
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00339270
RR MEDICARE
GA
Enumeration date
09/23/2005
Last updated
12/12/2007
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