Healthcare Provider Details

I. General information

NPI: 1649199118
Provider Name (Legal Business Name): MICHAEL TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MILL ST
ROSWELL GA
30075-4975
US

IV. Provider business mailing address

175 WALKABOUT WAY
DAHLONEGA GA
30533-5383
US

V. Phone/Fax

Practice location:
  • Phone: 770-403-0825
  • Fax:
Mailing address:
  • Phone: 678-910-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number014111
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: