Healthcare Provider Details

I. General information

NPI: 1215912670
Provider Name (Legal Business Name): DELISHA BRANTLEY TAYLOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5674 MEMORIAL DR
STONE MOUNTAIN GA
30083-3254
US

IV. Provider business mailing address

5674 MEMORIAL DR
STONE MOUNTAIN GA
30083-3254
US

V. Phone/Fax

Practice location:
  • Phone: 770-322-6161
  • Fax: 770-322-6191
Mailing address:
  • Phone: 770-322-6161
  • Fax: 770-322-6191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN145142
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN145142
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: