Healthcare Provider Details

I. General information

NPI: 1487287116
Provider Name (Legal Business Name): TEON TAYLOR APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 OLDE TOWNE PKWY STE 320
MARIETTA GA
30068-4357
US

IV. Provider business mailing address

PO BOX 117598
ATLANTA GA
30368-7598
US

V. Phone/Fax

Practice location:
  • Phone: 678-341-6370
  • Fax: 770-509-0601
Mailing address:
  • Phone: 770-442-1911
  • Fax: 770-442-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN-NP246167
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: