Individual provider Active NPI

Keith Chandler Taylor, ATC

  • Athletic Trainer
  • Augusta, GA
National Provider Identifier
1104070549
Registry record updated Apr 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
AT000386 Issued in GA
Practice address
1706 Magnolia Way
Augusta, GA 30909
Phone
(706) 210-7529
NPI assigned
Nov 12, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X AT000386 GA Primary

Addresses

Primary practice location

1706 Magnolia Way
Augusta, GA 30909

Mailing address

3624 J Dewey Gray Cir
Suite 308
Augusta, GA 30909-6584
Phone (706) 210-7529

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
AT000386GAMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Sports Medicine Associates of Augusta, LLC Past Accepting new patients
Sports Medicine Associates of Augusta, LLC PastSince Aug 1, 2005 Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1717/brand/1/csg/1/fhir/r4

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241049600000",
    "number": "1104070549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3624 J DEWEY GRAY CIR",
            "address_2": "SUITE 308",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309096584",
            "telephone_number": "706-210-7529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 MAGNOLIA WAY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "30909",
            "telephone_number": "706-210-7529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "KEITH",
        "middle_name": "CHANDLER",
        "name_prefix": "Mr.",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-12",
        "last_updated": "2009-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT000386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.