Healthcare Provider Details

I. General information

NPI: 1417917485
Provider Name (Legal Business Name): SHARON LYLE TAYLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 JEFFERSON HWY
WINDER GA
30680-3645
US

IV. Provider business mailing address

561 JEFFERSON HWY P. O. BOX 1508
WINDER GA
30680-3645
US

V. Phone/Fax

Practice location:
  • Phone: 770-867-7616
  • Fax:
Mailing address:
  • Phone: 770-867-7616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number029905
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: