MEDICARE: TAYLOR GARD FLETCHER M.D

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	207P00000X	Emergency Medicine Physician	G49762	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205889680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR GARD FLETCHER M.D

Provider Business Mailing Address
First Line	:	4532 COLLINS AVE
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30342-4125
Country	:	US
Telephone Number	:	951-233-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 JOHNSON FY RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1611
Country	:	US
Telephone Number	:	951-233-1900
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	01/07/2022

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