Healthcare Provider Details

I. General information

NPI: 1265055495
Provider Name (Legal Business Name): JEFFREY QUINN TAYLOR II MD, DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE # 2300B
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365 CLIFTON RD NE # 2300B
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 136-523-0030
  • Fax:
Mailing address:
  • Phone: 404-778-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number76583
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11824
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: