Healthcare Provider Details

I. General information

NPI: 1750260402
Provider Name (Legal Business Name): MRS. TAMMY ADAMS TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 BRIDGESTONE CV
FAYETTEVILLE GA
30215-8198
US

IV. Provider business mailing address

265 BRIDGESTONE CV
FAYETTEVILLE GA
30215-8198
US

V. Phone/Fax

Practice location:
  • Phone: 770-616-1685
  • Fax:
Mailing address:
  • Phone: 770-616-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberRN124177
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: