Provider Demographics
NPI:1609517457
Name:PETERS, TAYLOR DIANE (DO)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DIANE
Last Name:PETERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:PETERS
Other - Last Name:GENAWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:617 WENDOVER DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5443
Mailing Address - Country:US
Mailing Address - Phone:865-850-7715
Mailing Address - Fax:
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1971
Practice Address - Country:US
Practice Address - Phone:757-668-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program