Provider Demographics
NPI:1457630659
Name:TAYLOR, LAURA H (ATC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:H
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 KRIPPLE KREEK DR
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-1885
Mailing Address - Country:US
Mailing Address - Phone:404-353-7907
Mailing Address - Fax:
Practice Address - Street 1:1336 HIGHWAY 54 W
Practice Address - Street 2:BLDG 500
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4535
Practice Address - Country:US
Practice Address - Phone:770-461-6142
Practice Address - Fax:770-461-6271
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0010232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer