Provider Demographics
NPI:1356324198
Name:TAYLOR, JONATHAN WESLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:WESLEY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6208
Mailing Address - Country:US
Mailing Address - Phone:678-289-8377
Mailing Address - Fax:
Practice Address - Street 1:1920 HUDSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5038
Practice Address - Country:US
Practice Address - Phone:770-507-1234
Practice Address - Fax:770-507-1011
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist