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General NPI Number Information
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NPI Number | 1740201243
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Entity Type | Individual
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Provider Name | MARY C. TAYLOR M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1010 HOSPITAL DR
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7384
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Country | US
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Telephone | 678-289-8662
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Fax | 678-289-8691
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Provider Business Mailing Address
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Address Line | 950 EAGLES LANDING PKWY 261
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7343
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Country | US
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Telephone | 678-289-8662
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Fax | 678-289-8691
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 056372
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License Number State | GA
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