Provider Demographics
NPI:1932632312
Name:TAYLOR, GEORGE MALCOLM IV (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MALCOLM
Last Name:TAYLOR
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-1407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3400 HIGHWAY 78 E STE 316
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8951
Practice Address - Country:US
Practice Address - Phone:205-385-7860
Practice Address - Fax:205-385-7861
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162266208600000X
LA306149208600000X
AL49111208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118830000Medicaid
FLYIR0COtherBCBS