Individual provider Active NPI

Timothy Blake Taylor

  • Primary Care Nurse Practitioner
  • Valdosta, GA
National Provider Identifier
1356847743
Registry record updated Apr 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
RN235794 Issued in GA
Practice address
2412 N Oak St
Valdosta, GA 31602-2567
Phone
(229) 244-1400
Fax
(229) 244-5512
NPI assigned
Apr 4, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 4, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X RN235794 GA Primary

Addresses

Primary practice location

2412 N Oak St
Valdosta, GA 31602-2567

Mailing address

2412 N Oak St
Valdosta, GA 31602-2567
Phone (229) 244-1400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180904003293 GA Practitioner - Nurse Practitioner 2769732288 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valdosta Family Medicine Associates, P.C.Group PAC ID 5991791683, 37 clinicians

Practice addresses (Care Compare)

2412 N Oak St
Valdosta, GA 31602-2567
Phone (229) 244-1400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN235794GAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Georgia Emergency Medicine Associates PC CurrentSince Dec 15, 2019 Accepting new patients
Valdosta Family Medicine Associates, P.C. CurrentSince Apr 17, 2018 Accepting new patients

Locations

2501 N Patterson St
Valdosta, GA 31602
Phone (229) 259-4139

2412 N Oak St
Valdosta, GA 31602
Phone (229) 244-1400

4280 N Valdosta Rd
Valdosta, GA 31602
Phone (229) 433-7350

2418 N Oak St
Valdosta, GA 31602
Phone (229) 289-1517

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CHFDAA
  • Direct secure messaging: timothy.taylor@vfmapc.eclinicaldirectplus.com

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": "1522800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522800000000",
    "number": "1356847743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2412 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022567",
            "telephone_number": "229-244-1400",
            "fax_number": "229-244-5512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2412 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022567",
            "telephone_number": "229-244-1400",
            "fax_number": "229-244-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "TIMOTHY",
        "middle_name": "BLAKE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-04",
        "last_updated": "2018-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "RN235794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.