Provider Information for 1295200194
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Mr. TAYLOR SOUTH
Sex: Male
NPI: 1295200194
Last Updated: 2024-03-06
Certification Date: 2024-03-06
Certification Date: 2024-03-06
Details
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NPI | 1295200194 | ||||||||||||
Enumeration Date | 2018-10-06 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | YES | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 2802 MIRIAM ST S GULFPORT, FL 33711-3720 United States Phone: 602-819-8776 | Fax: | ||||||||||||
Primary Practice Address | 2802 MIRIAM ST S GULFPORT, FL 33711-3720 United States Phone: 602-819-8776 | Fax: | ||||||||||||
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