Healthcare Provider Details

I. General information

NPI: 1164412771
Provider Name (Legal Business Name): THOMAS K TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 ASTAIRE MNR
FAYETTEVILLE GA
30214-5362
US

IV. Provider business mailing address

125 ASTAIRE MNR
FAYETTEVILLE GA
30214-5362
US

V. Phone/Fax

Practice location:
  • Phone: 404-661-8858
  • Fax:
Mailing address:
  • Phone: 404-661-8858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number033121
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME72088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: