Provider Demographics
NPI:1902143878
Name:TAYLOR, BILLY CARSON (RPH)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:CARSON
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 GORNTO RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-8408
Mailing Address - Country:US
Mailing Address - Phone:229-333-2582
Mailing Address - Fax:229-242-5054
Practice Address - Street 1:1741 GORNTO RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-8408
Practice Address - Country:US
Practice Address - Phone:229-333-2582
Practice Address - Fax:229-242-5054
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist