MEDICARE: DR. PAMELA ANN TAYLOR PH.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	103TC1900X	Counseling Psychologist	PSY001827	GA
2	103T00000X	Psychologist	PSY001827	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0005479097	OTHER	GA	AETNA
2	52818639 003	OTHER	GA	BCBSGA

General Provider Information

NPI Number	:	1942299615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA ANN TAYLOR PH.D.

Provider Business Mailing Address
First Line	:	321 COLLEGE CIR
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30605-3629
Country	:	US
Telephone Number	:	706-372-6055
Fax Number	:	706-354-6972

Provider Business Practice Location Address
First Line	:	1551 JENNINGS MILL RD
Second Line	:	SUITE 2000B
City	:	BOGART
State	:	GA
Zip	:	30622-2544
Country	:	US
Telephone Number	:	706-372-6055
Fax Number	:	706-354-6972

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	09/11/2025

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