Provider Demographics
NPI:1215608930
Name:TAYLOR, CODY WILLIAM (PA-C)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:WILLIAM
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:530 N PATTERSON AVE UNIT 421
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-4281
Mailing Address - Country:US
Mailing Address - Phone:302-535-5749
Mailing Address - Fax:
Practice Address - Street 1:1695 KERNERSVILLE MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7159
Practice Address - Country:US
Practice Address - Phone:336-515-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-11408363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant