Healthcare Provider Details

I. General information

NPI: 1659648160
Provider Name (Legal Business Name): EVA TAYLOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5235 ARUBA CIR
AUGUSTA GA
30909-5795
US

IV. Provider business mailing address

5235 ARUBA CIR
AUGUSTA GA
30909-5795
US

V. Phone/Fax

Practice location:
  • Phone: 478-244-5999
  • Fax: 706-256-3264
Mailing address:
  • Phone: 478-244-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005429
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: