Provider Demographics
NPI:1366039059
Name:GRANT, TAYLOR (CPHT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 CASCADE PARC BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-5220
Mailing Address - Country:US
Mailing Address - Phone:678-544-8465
Mailing Address - Fax:
Practice Address - Street 1:303 PEACHTREE CENTER AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1216
Practice Address - Country:US
Practice Address - Phone:866-787-6341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician