Provider Demographics
NPI:1861590754
Name:TAYLOR, HENRY ALVIN II (DPM)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:ALVIN
Last Name:TAYLOR
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:127 MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4410
Mailing Address - Country:US
Mailing Address - Phone:912-876-8637
Mailing Address - Fax:912-867-4069
Practice Address - Street 1:127 MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4410
Practice Address - Country:US
Practice Address - Phone:912-876-8637
Practice Address - Fax:912-876-4069
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD 000649213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10058163OtherAMERIGROUP
GA6486480001OtherDMERC
GA636246997DMedicaid
GA341274OtherWELLCARE
GAP00144440OtherRAILROAD MEDICARE
GA845505OtherBLUE CROSS BLUE SHIELD
GAU19926Medicare UPIN
GA202G708956Medicare PIN