Provider Demographics
NPI:1124820105
Name:HELMBOLDT, TAYLOR JACK
Entity type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:JACK
Last Name:HELMBOLDT
Suffix:
Gender:
Credentials:
Other - Prefix:MR
Other - First Name:TAYLOR
Other - Middle Name:JACK
Other - Last Name:BOLDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:371 BUBBY DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1025
Mailing Address - Country:US
Mailing Address - Phone:865-803-6282
Mailing Address - Fax:
Practice Address - Street 1:920 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3438
Practice Address - Country:US
Practice Address - Phone:901-448-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program