Healthcare Provider Details

I. General information

NPI: 1942299615
Provider Name (Legal Business Name): PAMELA ANN TAYLOR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 JENNINGS MILL RD SUITE 2000B
BOGART GA
30622-2544
US

IV. Provider business mailing address

321 COLLEGE CIR
ATHENS GA
30605-3629
US

V. Phone/Fax

Practice location:
  • Phone: 706-372-6055
  • Fax: 706-354-6972
Mailing address:
  • Phone: 706-372-6055
  • Fax: 706-354-6972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY001827
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY001827
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: