Healthcare Provider Details

I. General information

NPI: 1427216449
Provider Name (Legal Business Name): TAYLOR BRANDON CATES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CLINIC AVE SUITE 101
CARROLLTON GA
30117-4401
US

IV. Provider business mailing address

150 CLINIC AVE SUITE 101
CARROLLTON GA
30117-4401
US

V. Phone/Fax

Practice location:
  • Phone: 770-834-0873
  • Fax: 770-834-6118
Mailing address:
  • Phone: 770-834-0873
  • Fax: 770-834-6118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number057587
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: