MEDICARE: NIA PHILISE TAYLOR

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	246Q00000X	Pathology Specialist/Technologist		GA

General Provider Information

NPI Number	:	1457219701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIA PHILISE TAYLOR

Provider Business Mailing Address
First Line	:	PO BOX 942388
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31141-2388
Country	:	US
Telephone Number	:	770-458-6101
Fax Number	:	770-455-4008

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	:	404-851-8000
Fax Number	:

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

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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