Provider Demographics
NPI:1619519543
Name:TAYLOR, SEAN SHURON
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:SHURON
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 GOSSAMER ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-5199
Mailing Address - Country:US
Mailing Address - Phone:678-294-8455
Mailing Address - Fax:
Practice Address - Street 1:7373 GOSSAMER ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-5199
Practice Address - Country:US
Practice Address - Phone:678-294-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor