MEDICARE: AUSTIN TURNER TAYLOR M.ED. CCC-SLP

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	235Z00000X	Speech-Language Pathologist	1212151	NC

General Provider Information

NPI Number	:	1982940334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN TURNER TAYLOR M.ED. CCC-SLP

Provider Business Mailing Address
First Line	:	1235 EAST BLVD STE E137
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5870
Country	:	US
Telephone Number	:	704-659-3957
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 EAST BLVD STE E137
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5870
Country	:	US
Telephone Number	:	704-659-3957
Fax Number	:

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

Provider Enumeration Date	:	12/12/2012
Last Update Date	:	10/19/2020

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Directions to “ AUSTIN TURNER TAYLOR M.ED. CCC-SLP” Practice Location

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