Healthcare Provider Details

I. General information

NPI: 1295136018
Provider Name (Legal Business Name): CHRISTA TAYLOR CMA (AAMA)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONNIE BEATY LPN (ARDMS ELIGIBLE)

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 ALLEY RD
ANDERSONVILLE TN
37705-3910
US

IV. Provider business mailing address

153 ALLEY RD
ANDERSONVILLE TN
37705-3910
US

V. Phone/Fax

Practice location:
  • Phone: 865-603-1738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: