Healthcare Provider Details

I. General information

NPI: 1902098916
Provider Name (Legal Business Name): TODD TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 ASBURY CIR HOSPITAL ANNEX-SUITE N340
ATLANTA GA
30322-1006
US

IV. Provider business mailing address

750 DARLINGTON CIR NE
ATLANTA GA
30305-2707
US

V. Phone/Fax

Practice location:
  • Phone: 706-380-1594
  • Fax:
Mailing address:
  • Phone: 706-380-1594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number202682
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: