Provider Demographics
NPI:1164759247
Name:BROSS, TARYN (TARYN DAVIDS)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:BROSS
Suffix:
Gender:F
Credentials:TARYN DAVIDS
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:
Other - Last Name:DAVIDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 4400, 9TH FLOOR, MEDICAL OFFICE TOWER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2208
Mailing Address - Country:US
Mailing Address - Phone:404-686-1850
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 4400, 9TH FLOOR, MEDICAL OFFICE TOWER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2208
Practice Address - Country:US
Practice Address - Phone:404-686-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062673207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology