Healthcare Provider Details

I. General information

NPI: 1184296477
Provider Name (Legal Business Name): TAYLOR NICOLE LOGGINS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 COURTENAY DR NE
ATLANTA GA
30306-3421
US

IV. Provider business mailing address

38 RAGAN DR
DALLAS GA
30157-0743
US

V. Phone/Fax

Practice location:
  • Phone: 404-875-4551
  • Fax:
Mailing address:
  • Phone: 323-637-4282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW009484
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: