Provider Demographics
NPI:1609849843
Name:TAYLOR, BEVERLY D (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:720 WESTVIEW DR SW STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1458
Mailing Address - Country:US
Mailing Address - Phone:404-736-1400
Mailing Address - Fax:404-736-5274
Practice Address - Street 1:1513 CLEVELAND AVE BLDG 500
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6903
Practice Address - Country:US
Practice Address - Phone:404-752-1000
Practice Address - Fax:404-752-1191
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2019-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA025053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00309801BMedicaid
B59431Medicare UPIN