Healthcare Provider Details

I. General information

NPI: 1073737680
Provider Name (Legal Business Name): DEBORAH A. TAYLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 CHURCH STREET SUITE 500
MARIETTA GA
30060
US

IV. Provider business mailing address

699 CHURCH STREET SUITE 500
MARIETTA GA
30060
US

V. Phone/Fax

Practice location:
  • Phone: 770-424-7100
  • Fax: 770-795-1969
Mailing address:
  • Phone: 770-424-7100
  • Fax: 770-795-1969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number058528
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD216568
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: