Healthcare Provider Details

I. General information

NPI: 1669087615
Provider Name (Legal Business Name): TAYLOR NICOLE EFAW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 01/10/2024
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 PARKWOOD AVE
CHATTANOOGA TN
37404
US

IV. Provider business mailing address

2717 EAST OAKLAND AVENUE
JOHNSON CITY TN
37601-1843
US

V. Phone/Fax

Practice location:
  • Phone: 423-624-1533
  • Fax:
Mailing address:
  • Phone: 423-926-2358
  • Fax: 423-926-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10105
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4334
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: