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NPI Code Detail

MEDICARE: JUDY GREENLEA TAYLOR DDS

MEDICARE: JUDY GREENLEA TAYLOR DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN010999GA

General Provider Information

NPI Number : 1003869736
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDY GREENLEA TAYLOR DDS
Provider Business Mailing Address
First Line : 6740 SHANNON PKWY
Second Line : STE. 2
City : UNION CITY
State : GA
Zip : 30291-2057
Country : US
Telephone Number : 770-306-2996
Fax Number :
Provider Business Practice Location Address
First Line : 440 WINN WAY
Second Line :
City : DECATUR
State : GA
Zip : 30030-1715
Country : US
Telephone Number : 404-508-7890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 07/08/2007

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Directions to “ JUDY GREENLEA TAYLOR DDS” Practice Location

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