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General NPI Number Information
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NPI Number | 1457937187
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Entity Type | Individual
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Provider Name | TAYLOR KRISTINE BERGSTROM
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Gender | Female
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 3280 HOWELL MILL RD NW STE 243
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City | ATLANTA
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State | GA
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Zip | 30327-4100
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Country | US
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Telephone | 678-215-1882
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Fax | 561-548-1743
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Provider Business Mailing Address
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Address Line | 1075 WHITLOCK AVE SW STE I
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City | MARIETTA
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State | GA
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Zip | 30064-1996
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Country | US
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Telephone | 678-215-1882
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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 | FL
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD305017
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License Number State | GA
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