Provider Demographics
NPI:1295479053
Name:MCCREDIE, TAYLOR J (ATC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:J
Last Name:MCCREDIE
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 1:1220 LEE ROAD 51 LOT 67
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-6530
Mailing Address - Country:US
Mailing Address - Phone:518-925-0831
Mailing Address - Fax:
Practice Address - Street 1:9075 HOLCOMB DR
Practice Address - Street 2:
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-4928
Practice Address - Country:US
Practice Address - Phone:518-925-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0045762255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer