Healthcare Provider Details

I. General information

NPI: 1609770312
Provider Name (Legal Business Name): MONIQUE RACHELLE TAYLOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 JONESBORO RD
MCDONOUGH GA
30253-3725
US

IV. Provider business mailing address

200 TRAVIS DR UNIT 2301
MCDONOUGH GA
30252-3167
US

V. Phone/Fax

Practice location:
  • Phone: 678-873-0020
  • Fax:
Mailing address:
  • Phone: 762-293-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateNULL

VIII. Authorized Official

Name: MONIQUE RACHELLE TAYLOR
Title or Position: OWNER
Credential: TRICHOLOGIST, DME
Phone: 762-293-5922