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NPI Code Detail

MEDICARE: TAYLOR LYNN HEACOCK MD

MEDICARE:   TAYLOR LYNN HEACOCK  MD
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
1207V00000XObstetrics & Gynecology Physician100050GA

General Provider Information

NPI Number : 1619596293
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR LYNN HEACOCK MD
Provider Business Mailing Address
First Line : 5780 PEACHTREE DUNWOODY RD STE 300
Second Line :
City : ATLANTA
State : GA
Zip : 30342-1513
Country : US
Telephone Number : 404-303-8035
Fax Number : 404-303-1325
Provider Business Practice Location Address
First Line : 3905 BROOKSIDE PKWY STE 105
Second Line :
City : ALPHARETTA
State : GA
Zip : 30022-4457
Country : US
Telephone Number : 770-751-3600
Fax Number : 770-751-3615
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2020
Last Update Date : 06/20/2024

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Directions to “ TAYLOR LYNN HEACOCK MD” Practice Location

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