Healthcare Provider Details

I. General information

NPI: 1073964508
Provider Name (Legal Business Name): JULIA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 E NC HIGHWAY 54 BLDG 2000
DURHAM NC
27713-5263
US

IV. Provider business mailing address

2515 E NC HIGHWAY 54 BLDG 2000
DURHAM NC
27713-5263
US

V. Phone/Fax

Practice location:
  • Phone: 919-493-0959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP010576
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: