1215213392 NPI number — MRS. TANJA LYNETTE TAYLOR OT, CHT

Table of content: MRS. TANJA LYNETTE TAYLOR OT, CHT (NPI 1215213392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215213392 NPI number — MRS. TANJA LYNETTE TAYLOR OT, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
TANJA
Provider Middle Name:
LYNETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OT, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215213392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 WISTERIA DR STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNELLVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30078-2689
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-982-0102
Provider Business Mailing Address Fax Number:
770-982-0130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 MCCLURE BRIDGE RD STE F601
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30096-8740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-682-8828
Provider Business Practice Location Address Fax Number:
678-682-8830
Provider Enumeration Date:
11/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  000633 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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