Provider Demographics
NPI:1013369016
Name:WHEATON, TAYLOR WARWICK CHARLES (ATC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:WARWICK CHARLES
Last Name:WHEATON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 LEGEND RUN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2282
Mailing Address - Country:US
Mailing Address - Phone:678-925-2697
Mailing Address - Fax:
Practice Address - Street 1:1255 LEGEND RUN
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2282
Practice Address - Country:US
Practice Address - Phone:678-925-2697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0027952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer