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General NPI Number Information
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NPI Number | 1457630659
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Entity Type | Individual
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Provider Name | LAURA H TAYLOR ATC
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Gender | Female
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 1336 HIGHWAY 54 W BLDG 500
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4535
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Country | US
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Telephone | 770-461-6142
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Fax | 770-461-6271
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Provider Business Mailing Address
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Address Line | 240 KRIPPLE KREEK DR
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City | SHARPSBURG
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State | GA
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Zip | 30277-1885
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Country | US
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Telephone | 404-353-7907
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT001023
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License Number State | GA
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