Provider Demographics
NPI:1326611229
Name:SMITH, TAYLOR B
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:B
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5342 10TH ARMORED LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT MOORE
Mailing Address - State:GA
Mailing Address - Zip Code:31905-7089
Mailing Address - Country:US
Mailing Address - Phone:512-915-9177
Mailing Address - Fax:
Practice Address - Street 1:5342 10TH ARMORED LOOP
Practice Address - Street 2:
Practice Address - City:FORT MOORE
Practice Address - State:GA
Practice Address - Zip Code:31905-7089
Practice Address - Country:US
Practice Address - Phone:512-915-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst