Healthcare Provider Details

I. General information

NPI: 1912153784
Provider Name (Legal Business Name): EDWIN TOM TAYLOR MD, FAAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 N 3RD AVE
CHATSWORTH GA
30705-2118
US

IV. Provider business mailing address

165 BLUE RIDGE OVERLOOK
BLUE RIDGE GA
30513-4431
US

V. Phone/Fax

Practice location:
  • Phone: 706-517-2273
  • Fax: 706-517-2469
Mailing address:
  • Phone: 706-946-5607
  • Fax: 706-374-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number83438
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: