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General NPI Number Information
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NPI Number | 1194450353
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Entity Type | Individual
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Provider Name | NIA RENEE TAYLOR DMD
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Gender | Female
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 1135 HIGHWAY 85 N STE A
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2085
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Country | US
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Telephone | 770-282-2160
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Fax |
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Provider Business Mailing Address
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Address Line | 2833 LAKE PARK DR
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City | JONESBORO
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State | GA
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Zip | 30236-4133
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Country | US
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Telephone | 205-790-2151
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN122822
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License Number State | GA
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