Healthcare Provider Details

I. General information

NPI: 1346709623
Provider Name (Legal Business Name): TAYLOR QUATTLEBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 STATE FARM RD
BOONE NC
28607-4948
US

IV. Provider business mailing address

PO BOX 1490
BOONE NC
28607-0682
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-3886
  • Fax: 828-265-4816
Mailing address:
  • Phone: 828-262-3886
  • Fax: 828-265-4816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2022-00178
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: