MEDICARE: RANDOLPH TAYLOR II M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	P7580	TX
2	207Q00000X	Family Medicine Physician	ME 113093	FL
3	207Q00000X	Family Medicine Physician	83783	GA

General Provider Information

NPI Number	:	1386820553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDOLPH TAYLOR II M.D

Provider Business Mailing Address
First Line	:	4441 ATLANTA RD SE STE 216
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6442
Country	:	US
Telephone Number	:	470-956-4120
Fax Number	:	678-842-5535

Provider Business Practice Location Address
First Line	:	4441 ATLANTA RD SE STE 216
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6442
Country	:	US
Telephone Number	:	470-956-4120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	03/13/2023

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