MEDICARE: ROBERT E. TAYLOR D.O.

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	207Q00000X	Family Medicine Physician	031338	GA

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	:	1700879012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT E. TAYLOR D.O.

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:	770-219-8440

Provider Business Practice Location Address
First Line	:	5281 CLEVELAND HWY
Second Line	:
City	:	CLERMONT
State	:	GA
Zip	:	30527-2205
Country	:	US
Telephone Number	:	770-983-7611
Fax Number	:	770-983-9143

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	10/14/2020

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