1255656039 NPI number — MS. NIEFA ANTOINETTE TAYLOR LPC

Table of content: MS. NIEFA ANTOINETTE TAYLOR LPC (NPI 1255656039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255656039 NPI number — MS. NIEFA ANTOINETTE TAYLOR LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
NIEFA
Provider Middle Name:
ANTOINETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1255656039
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
165 BURKE ST
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
STOCKBRIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30281-3463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-563-5189
Provider Business Mailing Address Fax Number:
678-623-3748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 BURKE ST
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281-3463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-563-5189
Provider Business Practice Location Address Fax Number:
678-623-3748
Provider Enumeration Date:
04/05/2010

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: 101YP2500X , with the licence number:  LPC 006345 , 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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