Provider Demographics
NPI:1306625405
Name:THURMOND, TAYLOR MARIE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:THURMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 THURMOND POSS DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:GA
Mailing Address - Zip Code:30817-2166
Mailing Address - Country:US
Mailing Address - Phone:706-597-6858
Mailing Address - Fax:
Practice Address - Street 1:1537 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-3764
Practice Address - Country:US
Practice Address - Phone:706-731-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN323471163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse