Healthcare Provider Details

I. General information

NPI: 1366039059
Provider Name (Legal Business Name): TAYLOR GRANT CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PEACHTREE CENTER AVE NE
ATLANTA GA
30303-1216
US

IV. Provider business mailing address

3409 CASCADE PARC BLVD SW
ATLANTA GA
30311-5220
US

V. Phone/Fax

Practice location:
  • Phone: 866-787-6341
  • Fax:
Mailing address:
  • Phone: 678-544-8465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: