Healthcare Provider Details

I. General information

NPI: 1386901288
Provider Name (Legal Business Name): DANIELLE LYNN TAYLOR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 GEORGE C. WILSON DRIVE
AUGUSTA GA
30909
US

IV. Provider business mailing address

3696 WHEELER RD
AUGUSTA GA
30909-6520
US

V. Phone/Fax

Practice location:
  • Phone: 706-941-8206
  • Fax:
Mailing address:
  • Phone: 67-361-8307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number83009
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: