Healthcare Provider Details

I. General information

NPI: 1700879012
Provider Name (Legal Business Name): ROBERT E. TAYLOR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5281 CLEVELAND HWY
CLERMONT GA
30527-2205
US

IV. Provider business mailing address

PO BOX 742616
ATLANTA GA
30374-2616
US

V. Phone/Fax

Practice location:
  • Phone: 770-983-7611
  • Fax: 770-983-9143
Mailing address:
  • Phone: 770-219-8420
  • Fax: 770-219-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number031338
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: