MEDICARE: DR. BENJAMIN EUGENE TAYLOR 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
1	363A00000X	Physician Assistant	C0003283	MD
2	363AM0700X	Medical Physician Assistant	AMD462	HI
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1669480729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN EUGENE TAYLOR MD

Provider Business Mailing Address
First Line	:	100 WOODRUFF CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1020
Country	:	US
Telephone Number	:	305-804-1684
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WOODRUFF CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1020
Country	:	US
Telephone Number	:	305-804-1684
Fax Number	:

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	06/14/2023

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