Provider Demographics
NPI:1053316109
Name:TAYLOR, KENNETH GORDON (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:GORDON
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:275 COLLIER RD NW
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1709
Mailing Address - Country:US
Mailing Address - Phone:404-605-2800
Mailing Address - Fax:404-351-5983
Practice Address - Street 1:275 COLLIER RD NW
Practice Address - Street 2:SUITE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1709
Practice Address - Country:US
Practice Address - Phone:404-605-2800
Practice Address - Fax:404-351-5983
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA038985204F00000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000658039KLNPQRSTUVWMedicaid
GA202I061133Medicare PIN
F69852Medicare UPIN