Provider Demographics
NPI:1407501422
Name:BANKS, TAYLA (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3645 MARKETPLACE BLVD STE 130 BOX 161
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344
Mailing Address - Country:US
Mailing Address - Phone:662-457-1791
Mailing Address - Fax:
Practice Address - Street 1:1275 HIGHWAY 54 W STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4538
Practice Address - Country:US
Practice Address - Phone:770-461-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant