MEDICARE: KAMIL DENISE TAYLOR-DIGGS LMSW

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
1	103K00000X	Behavior Analyst
2	104100000X	Social Worker	MSW008816	GA

General Provider Information

NPI Number	:	1144505777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMIL DENISE TAYLOR-DIGGS LMSW

Provider Business Mailing Address
First Line	:	182 ODYSSEY TURN
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30012-3680
Country	:	US
Telephone Number	:	310-890-1411
Fax Number	:

Provider Business Practice Location Address
First Line	:	5255 SNAPFINGER PARK DR STE 120
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30035-4066
Country	:	US
Telephone Number	:	678-389-4856
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2011
Last Update Date	:	05/04/2019

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