Provider Demographics
NPI:1235799354
Name:TAYLOR, RAYMOND D (DC)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 HARRIS FARMS WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106
Mailing Address - Country:US
Mailing Address - Phone:770-427-2799
Mailing Address - Fax:770-427-2243
Practice Address - Street 1:4200 WADE GREEN ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1808
Practice Address - Country:US
Practice Address - Phone:770-427-2799
Practice Address - Fax:770-427-2243
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor