Provider Demographics
NPI:1619144342
Name:TAGGART, JULIE TAYLOR (DO)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:TAYLOR
Last Name:TAGGART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:MISTY
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:P.O. BOX 359
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-381-3030
Mailing Address - Fax:931-381-6220
Practice Address - Street 1:808 JENLAND DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-381-3030
Practice Address - Fax:931-381-6220
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000002549174400000X
LADO.000231207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1533180Medicaid